removal of bone spurring during cervical ADR

[necknose]

Hi Mark:

Your three legged stool analogy is helpful in forming a picture of the structural realities confronting the ADR surgeon who is tasked with "remodelling" vertebral bone and implanting ADR's.

The issue of "bone wax" is vexing because the complete removal of osteophytes is, as I understand it, the key to a successful multi-level ADR surgery. E.G.: there's no sense in having an ADR implanted if the implanted level is only going to auto-fuse sometime soon, say within a decade of the ADR implantation, especially when there are multiple levels implanted. Thus my concern about osteophyte removal and the prevention, in a "healthy" manner, of the regeneration of these pesky bone deposits.

As you have mentioned in the past the methods surgeons use to prevent the regrowth of these spurs is the application of "bone wax" to the area where bone has been removed, especially bone which has been removed aggressively thus probably triggering the body's tendancy to just as aggressively attempt to replace this "missing" bone. One doesn't simply want a latent problem replacing an overt one, nor to end up with exactly what one sets out to avoid, auto-fusion. The dynamics of this aspect of spine surgery, osteophyte removal and the prevention of their regrowth, are complex and far beyond my understanding of this ssurgery. However as can be seen from my previous posts gaining a basic understanding of this issue is in my view essential to the responsible treatment of one's spine disease.

It would be fantastic if you could consult your top docs about the material they use for "bone wax", and in their opinion the cons if any, arising from the use of this material.

Happy Thanksgiving!

Good luck.

[mmglobal]

Saturday, I had Zeegers as a captive teacher for many hours as we traveled trom Munich to Nijmegen (Holland) together... about 4 hours in transit. We discussed the use of bone wax pretty extensively. He's used it for decades in various orthopedic applications. Zero infections.... never had a problem related to bone wax. It's an interesting compound that is frequently misused. It must be used sparingly... apply it and wipe it all off.... the minor amount that remains does it's job.

[necknose]

Originally Posted by mmglobal

Saturday, I had Zeegers as a captive teacher for many hours as we traveled trom Munich to Nijmegen (Holland) together... about 4 hours in transit. We discussed the use of bone wax pretty extensively. He's used it for decades in various orthopedic applications. Zero infections.... never had a problem related to bone wax. It's an interesting compound that is frequently misused. It must be used sparingly... apply it and wipe it all off.... the minor amount that remains does it's job.

Reminiscent of that famous Bill Clinton campaign slogan: "it's the economy stupid".

It seems that no matter what the aspect of surgery the single most important qualitative variable is the: THE DOCTOR!!!! I think we in this country tend to forget this being subjected to wholesale 15 minute slivers of "medicine". We are taught little commonsense, how much do kids get commonsense from a 5-10 hr a day diet of GrimTime TeeVee? And how much commonsense have you gotten from your doc lately? So mostly the bone wax (does Zeegers use bee's wax & paraffin?) is a tempest in a candlestick holder. And so it goes.

Mark: as usual, thanks for the info..

Good luck!

[mmglobal]

I got to spend some time with Dr. Bertagnoli last week. We discussed the use of bone wax and the potential for infection. Said Dr. B:

If my infection rate was zero before I started using bone wax, and zero since I started using it, I think it's safe to say that the use of bone wax does not cause infection.

I questioned further about his experience. He's been using it for over a year... approximately 60 case.

Mark

[ADR seeker]

Bone wax was used during the civil war. It is bees wax. It inhibits bone growth.

It is said that it also makes the bone unable to deal with infection and that Ostene a synthetic bone wax doesn't. Also I can't find is Ostene inhibits bone growth.

As far as I know bone wax/ bees wax is the only thing that inhibits bone regrowth. I'm not sure if that is true. You'd think that since the Civil war there would be a better alternative to bees wax.

[ADR seeker]

Long-term results of surgical treatment of dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis.
Urrutia J, Bono CM.
Source

Department of Orthopaedic Surgery, Pontificia Universidad Catolica de Chile, Marcoleta 352, Santiago, Region Metropolitana, Chile. jurrutia@med.puc.cl
Abstract
BACKGROUND CONTEXT:

Large, prominent osteophytes along the anterior aspect of the cervical spine have been reported as a cause of dysphagia. Improvement of swallowing after surgical resection has been reported in a few case reports with short-term follow-up. The current report describes outcomes of a series of five patients with surgical treatment for this rare disorder, with a long-term follow-up.
PURPOSE:

To study the clinical and radiographic outcomes of a case series of patients surgically treated for dysphagia secondary to cervical diffuse idiopathic skeletal hyperostosis (DISH).
STUDY DESIGN:

Retrospective review of a case series.
PATIENT SAMPLE:

Five cases from a University Hospital.
OUTCOME MEASURES:

Clinical and imagenological follow-up.
METHODS:

The records of five patients with dysphagia who had undergone anterior surgical resection of prominent osteophytes secondary to DISH were reviewed. Extrinsic esophageal compression secondary to anterior cervical osteophytes was radiographically confirmed via preoperative barium esophagogram swallowing study. All patients underwent anterior cervical osteophytes resection without fusion. Postoperatively, patients were followed-up clinically and radiographically with routine lateral cervical radiographs.
RESULTS:

Preoperative esophagogram showed that the esophageal obstruction was present at one level in three cases and two levels in two cases. The C3-C4 level was involved in three cases, C4-C5 in three cases, and C5-C6 in one case. There were no postoperative complications, including recurrent laryngeal nerve palsy, wound infection, or hematomas. All patients had resolution of dyphagia soon after surgery (within 2 weeks). Postoperative radiographs demonstrated complete removal of osteophytes. At final follow-up, ranging from 1 to 9 years (average 59.8 months, median 53 months), no patients reported recurrence of dysphagia. Final radiographic examination demonstrated minimal regrowth of the osteophytes.
CONCLUSIONS:

Although rarely indicated, surgical resection of anterior cervical osteophytes from DISH causing dyphagia produces good clinical and radiographical outcomes. After thorough evaluation to rule out other intrinsic or extrinsic causes of swallowing difficulty, surgical treatment of this uncommon condition might be considered.

Long-term results of surgical treatment of dysphagia... [Spine J. 2009] - PubMed - NCBI