Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern

Abstract

IntroductionAnterior cervical discectomy and fusion (ACDF) in the subaxial cervical spine as originally suggested by Badgley in 1939 and described by Robinson and Smith in 1955 [28] and Cloward in 1958 [8] has established itself as a method of treatment for patients with neural compression by disc material or osteophytes.Although the interbody location of applied bone graft is a favourable healing environment, because of the relatively large surface area of subchondral cancellous bone Abstract Background. The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature. Methods. Seventy-nine consecutive patients were operated on using the Smith-Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years. Results.The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one-and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.Conclusions.This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and nonsmokers in the rate or course of fusion as previously reported.

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

“…In this study, ASD was also the most common reason for a new intervention in the ACDF group, while intervention for pseudarthrosis was less than 1% which is lower than found in another retrospective study of 672 patients [23], but consistent with other publications [24,25]. A majority of patients in this cohort were treated with iliac crest bone and plating which might create better conditions for healing than alternative methods [26][27][28]. It should also be pointed out that pseudarthrosis could be a difficult diagnosis to establish as there is no sufficiently accurate radiological method to ensure very small movements in non-healed segments [29,30].…”

Substitutos ósseos comparados ao enxerto ósseo autólogo em cirurgia ortopédica: revisão sistemática da literatura

“…No entanto, há críticas quanto a esses resultados. No estudo de Suchomel et al, as análises foram feitas unicamente a partir de radiografias simples, com margens a erro de interpretação (4) . No artigo de Löfgren et al, a casuísti-ca de 43 pacientes é dividida em três grupos (osso autólogo, homólogo e heterólogo), o que aumenta a margem de erro estatística (8) .…”

“…Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and Suchomel et al (4) fusion: a prospective study with respect to bone union pattern.…”

“…O substituto ósseo mostrou-se equivalente ao enxerto autólogo em 19 estudos (4)(5)(6)(7)(8)(9)(10)(11)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) e inferior em três (12,(24)(25) .…”

“…Dos 22 artigos, 19 fizeram referência a cirurgias da coluna vertebral (4)(5)(6)(7)(8)(9)(10)(14)(15)(17)(18)(19)(20)(21)(22)(23)(24)(25) e três a cirurgias do esqueleto apendicular (11,13,16) , fazendo com que todos os 22 trabalhos fossem considerados em conjunto, sem distinção entre os diferentes tipos de esqueleto.…”