The i-Factor bone graft (Cerapedics Inc, Westminster, Colorado) (i-factor), a bone substitute material, is a combination product consisting of P-15, which is adsorbed onto anorganic bone mineral suspended in an insert biocompatible hydrogel carrier. With the development of various surgical materials, such as synthetic cages and bone-inductive substances, cervical stability and fusion rates after ACDF have significantly improved. Further biomechanical studies are required to determine the optimal dose and usage instruction of i-factor.Īnterior cervical discectomy and fusion (ACDF) is considered the “gold standard” treatment for degenerative cervical disease with instability and kyphosis involving two or more levels. The unexpected bone formation causing dysphagia that we observed may be due to the high potent bone-inductive capacity of i-factor, but instead because there are no guidelines on proper dosage and usage. Computed tomography (CT) scan revealed the presence of a bridging bone at the graft level, but showed unexpected bone formation in the anterior portion of the vertebral body. The patient developed mild dysphagia 3 months after surgery. The appropriate PEEK cage was selected, filled with 1 mL of i-factor 1 mL that was intermixed with autologous bone chips. A 67-year-old male patient underwent stand-alone ACDF surgery at the C3–4 level. A simple cervical spine radiograph showed unexpected bone formation in the anterior portion of the vertebral body at C6 and C7 levels. The appropriate PEEK cage was selected, filled with an i-factor 2.5 mL divided into 1/3 that was intermixed with autologous bone chips, The patient developed mild dysphagia 1 month after surgery.
A 60-year-old male patient underwent stand-alone ACDF surgery at the C4–5–6–7 level. Herein, we discuss two cases that presented unexpected bone formation after ACDF using polyetheretherketone (PEEK) cage with i-factor. Clinical studies with i-factor have thus far been shown favorable results, despite theoretical concerns moreover, no adverse events related to i-factor after ACDF have been reported. Several recent studies have revealed that anterior cervical discectomy and fusion (ACDF) with i-factor, a bone substitute material, is safe and effective, with a superior fusion rate.
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