Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis

Restricted access

✓ The authors conducted a prospective study of 132 patients requiring interbody fusion without instrumentation following anterior cervical discectomy to compare the efficacy of tricortical iliac crest allograft versus autograft fusion substrates. The objectives of the study were to assess the potential differences in interspace collapse, angulation, maintenance of cervical alignment and lordosis, and clinical and radiographic fusion success rates between the two fusion substrates. The impact of habitual cigarette smoking on fusion rates was also examined.

Autograft tricortical iliac crest bone was found to be superior to allograft bone as an interbody fusion substrate after both single- and multiple-level anterior cervical decompression procedures with respect to maintenance of cervical interspace height, interspace angulation, and radiographic and clinical fusion success rates. Cigarette consumption had a significant adverse effect on successful anterior cervical interbody fusion for both autograft and allograft substrate, an effect that was most pronounced among smokers treated with allograft bone (p = 0.004).

Article Information

Address reprint requests to: Mark N. Hadley, M.D., Division of Neurosurgery, 511 Medical Education Building, 1813 Sixth Avenue South, Birmingham, Alabama 35294–3295.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Drawing showing how disc space height and angle for each level that was fused were determined and then followed with serial radiographs.

  • View in gallery

    Left: Postoperative radiograph displaying a C5–6 autograft interbody fusion 4 weeks after surgery. Right: Postoperative radiograph obtained in the same patient 9 months after surgery. Note radiographic fusion and preservation of interspace angle and height.

References

  • 1.

    Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72:3703771990Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72:370–377 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Broulik PDJaráb J: The effect of chronic nicotine administration on bone mineral content in mice. Horm Metab Res 25:2192211993Broulik PD Jaráb J: The effect of chronic nicotine administration on bone mineral content in mice. Horm Metab Res 25:219–221 1993

    • Search Google Scholar
    • Export Citation
  • 3.

    Brown MDMalinin TIBrown PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:2312361976Brown MD Malinin TI Brown PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:231–236 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    Church DFPryor WA: Free-radical chemistry of cigarette smoke and its toxicological implications. Environ Health Perspect 64:1111261985Church DF Pryor WA: Free-radical chemistry of cigarette smoke and its toxicological implications. Environ Health Perspect 64:111–126 1985

    • Search Google Scholar
    • Export Citation
  • 5.

    Daftari TKWhitesides TE JrHeller JGet al: Nicotine on the revascularization of bone graft. An experimental study in rabbits. Spine 19:9049111994Daftari TK Whitesides TE Jr Heller JG et al: Nicotine on the revascularization of bone graft. An experimental study in rabbits. Spine 19:904–911 1994

    • Search Google Scholar
    • Export Citation
  • 6.

    DePalma AFRothman RHLewinnek GE: Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:7557581972DePalma AF Rothman RH Lewinnek GE: Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:755–758 1972

    • Search Google Scholar
    • Export Citation
  • 7.

    de Vernejoul MCBielakoff JHerve Met al: Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men. Clin Orthop 179:1071151983de Vernejoul MC Bielakoff J Herve M et al: Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men. Clin Orthop 179:107–115 1983

    • Search Google Scholar
    • Export Citation
  • 8.

    Fang MAFrost PJIida-Klein Aet al: Effects of nicotine on cellular function in UMR 106-01 osteoblast-like cells. Bone 12:2832861991Fang MA Frost PJ Iida-Klein A et al: Effects of nicotine on cellular function in UMR 106-01 osteoblast-like cells. Bone 12:283–286 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Hadley MNSonntag VKH: Cervical disc herniations. The anterior approach to symptomatic interspace pathology. Neurosurg Clin North Am 4:45521993Hadley MN Sonntag VKH: Cervical disc herniations. The anterior approach to symptomatic interspace pathology. Neurosurg Clin North Am 4:45–52 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Hankinson HLWilson CB: Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43:4524561975Hankinson HL Wilson CB: Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43:452–456 1975

    • Search Google Scholar
    • Export Citation
  • 11.

    Hanley ENHarvel JCShapiro DE: Use of allograft bone in cervical spine surgery. Semin Spine Surg 5:2332381992 [Reference Unverified]Hanley EN Harvel JC Shapiro DE: Use of allograft bone in cervical spine surgery. Semin Spine Surg 5:233–238 1992 [Reference Unverified]

    • Search Google Scholar
    • Export Citation
  • 12.

    Heiple KGChase SWHerndon CH: A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg (Am) 45:159316161963Heiple KG Chase SW Herndon CH: A comparative study of the healing process following different types of bone transplantation. J Bone Joint Surg (Am) 45:1593–1616 1963

    • Search Google Scholar
    • Export Citation
  • 13.

    Hollenback KABarrett-Connor EEdelstein SLet al: Cigarette smoking and bone mineral density in older men and women. Am J Publ Health 83:126512701993Hollenback KA Barrett-Connor E Edelstein SL et al: Cigarette smoking and bone mineral density in older men and women. Am J Publ Health 83:1265–1270 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Hopper JLSeeman E: The bone density of female twins discordant for tobacco use. N Engl J Med 330:3873921994Hopper JL Seeman E: The bone density of female twins discordant for tobacco use. N Engl J Med 330:387–392 1994

    • Search Google Scholar
    • Export Citation
  • 15.

    Hussain MKFrantz ABCiarochi Fet al: Nicotine-stimulated release of neurophysin and vasopressin in humans. J Endocrinol Metab 41:111311171975Hussain MK Frantz AB Ciarochi F et al: Nicotine-stimulated release of neurophysin and vasopressin in humans. J Endocrinol Metab 41:1113–1117 1975

    • Search Google Scholar
    • Export Citation
  • 16.

    Kaufman HHJones E: The principles of bony spinal fusion. Neurosurgery 24:2642701989Kaufman HH Jones E: The principles of bony spinal fusion. Neurosurgery 24:264–270 1989

    • Search Google Scholar
    • Export Citation
  • 17.

    Kirkpatrick JSHadley MN: Autograft vs. alloimplant bone as substrate for spinal fusion. Perspect Neurol Surg 4:38481993Kirkpatrick JS Hadley MN: Autograft vs. alloimplant bone as substrate for spinal fusion. Perspect Neurol Surg 4:38–48 1993

    • Search Google Scholar
    • Export Citation
  • 18.

    Kurz LTGarfin SRBooth RE Jr: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:132413311989Kurz LT Garfin SR Booth RE Jr: Harvesting autogenous iliac bone grafts. A review of complications and techniques. Spine 14:1324–1331 1989

    • Search Google Scholar
    • Export Citation
  • 19.

    Malinin TIBrown MD: Bone allografts in spinal surgery. Clin Orthop 154:68731981Malinin TI Brown MD: Bone allografts in spinal surgery. Clin Orthop 154:68–73 1981

    • Search Google Scholar
    • Export Citation
  • 20.

    Pelker RRFreidlander GEMarkham TC: Biomechanical properties of bone allografts. Clin Orthop 174:54571983Pelker RR Freidlander GE Markham TC: Biomechanical properties of bone allografts. Clin Orthop 174:54–57 1983

    • Search Google Scholar
    • Export Citation
  • 21.

    Prolo DJ: Biology of bone fusion. Clin Neurosurg 36:1351461990Prolo DJ: Biology of bone fusion. Clin Neurosurg 36:135–146 1990

  • 22.

    Prolo DJOklund SA: Bone healing and grafting in spinal surgery in Hitchon PWTrayelis VCRengachary SS (eds): Techniques in Spinal Fusion and Stabilization. New York: Thieme1995 pp 7278Prolo DJ Oklund SA: Bone healing and grafting in spinal surgery in Hitchon PW Trayelis VC Rengachary SS (eds): Techniques in Spinal Fusion and Stabilization. New York: Thieme 1995 pp 72–78

    • Search Google Scholar
    • Export Citation
  • 23.

    Prolo DJRodrigo JJ: Contemporary bone graft physiology and surgery. Clin Orthop 200:3223421985Prolo DJ Rodrigo JJ: Contemporary bone graft physiology and surgery. Clin Orthop 200:322–342 1985

    • Search Google Scholar
    • Export Citation
  • 24.

    Riley LH JrRobinson RAJohnson KA: The results of anterior interbody fusion of the cervical spine. Review of ninety-three consecutive cases. J Neurosurg 30:1271331969Riley LH Jr Robinson RA Johnson KA: The results of anterior interbody fusion of the cervical spine. Review of ninety-three consecutive cases. J Neurosurg 30:127–133 1969

    • Search Google Scholar
    • Export Citation
  • 25.

    Rish BLMcFadden JTPenix JO: Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5:1191211976Rish BL McFadden JT Penix JO: Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5:119–121 1976

    • Search Google Scholar
    • Export Citation
  • 26.

    Robinson RAWalker AEFerlic DC: The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg (Am) 44:156915871962Robinson RA Walker AE Ferlic DC: The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg (Am) 44:1569–1587 1962

    • Search Google Scholar
    • Export Citation
  • 27.

    Rotruck JTPope ALGanther HEet al: Selenium: biochemical role as a component of glutathione peroxidase. Science 79:5885901973Rotruck JT Pope AL Ganther HE et al: Selenium: biochemical role as a component of glutathione peroxidase. Science 79:588–590 1973

    • Search Google Scholar
    • Export Citation
  • 28.

    Rubenstein IYong TRennard SIet al: Cigarette smoke extract attenuates endothelium-dependent arteriolar dilation in vivo. Am J Physiol 261:H1913H19181991Rubenstein I Yong T Rennard SI et al: Cigarette smoke extract attenuates endothelium-dependent arteriolar dilation in vivo. Am J Physiol 261:H1913–H1918 1991

    • Search Google Scholar
    • Export Citation
  • 29.

    Urist MR: Bone: formation by autoinduction. Science 150:8938991965Urist MR: Bone: formation by autoinduction. Science 150:893–899 1965

    • Search Google Scholar
    • Export Citation
  • 30.

    Urist MR: Bone transplants and implants in Urist MR (ed): Fundamental and Clinical Bone Physiology. Philadelphia: JB Lippincott1980 pp 331368Urist MR: Bone transplants and implants in Urist MR (ed): Fundamental and Clinical Bone Physiology. Philadelphia: JB Lippincott 1980 pp 331–368

    • Search Google Scholar
    • Export Citation
  • 31.

    White AA IIISouthwick WODeponte RJ: Relief of pain by anterior cervical-spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg (Am) 55:5255341973White AA III Southwick WO Deponte RJ: Relief of pain by anterior cervical-spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg (Am) 55:525–534 1973

    • Search Google Scholar
    • Export Citation
  • 32.

    Whitecloud TS III: Complications of anterior cervical fusion. Instr Course Lect 27:2232271976Whitecloud TS III: Complications of anterior cervical fusion. Instr Course Lect 27:223–227 1976

    • Search Google Scholar
    • Export Citation
  • 33.

    Zdeblick TADucker TB: The use of freeze-dried allograft for anterior cervical fusions. Spine 16:7267291991Zdeblick TA Ducker TB: The use of freeze-dried allograft for anterior cervical fusions. Spine 16:726–729 1991

    • Search Google Scholar
    • Export Citation
  • 34.

    Zdeblick TAWilson DCooke MEet al: Anterior cervical discectomy and fusion. A comparison of techniques in an animal model. Spine 17 (Suppl 10):S418S4261992Zdeblick TA Wilson D Cooke ME et al: Anterior cervical discectomy and fusion. A comparison of techniques in an animal model. Spine 17 (Suppl 10):S418–S426 1992

    • Search Google Scholar
    • Export Citation

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 282 282 118
Full Text Views 208 185 3
PDF Downloads 107 93 2
EPUB Downloads 0 0 0

PubMed

Google Scholar