Techniques for cervical interbody grafting

Restricted access

Object

The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgerons/Congress of Neurological Surgeons.

Results

Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23–27% (especially local edema) compared with 3% for a standard approach.

Conclusions

Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.

Abbreviations used in this paper: ACDF = anterior cervical discectomy with fusion; CFC = carbon fiber cage; mJOA = modified Japanese Orthopaedic Association; NDI = neck disability index; PEEK = polyetheretherketone; PMMA = polymethyl-methylmethacrylate; rhBMP-2 = recombinant human bone morphogenic protein-2; VAS = visual analog scale.

Article Information

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg@yahoo.com.

© AANS, except where prohibited by US copyright law.

Headings

References

  • 1

    An HSSimpson JMGlover JMStephany J: Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 20:221122161995

    • Search Google Scholar
    • Export Citation
  • 2

    Bärlocher CBBarth AKrauss JKBinggeli RSeiler RW: Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 12:2E42002

    • Search Google Scholar
    • Export Citation
  • 3

    Baskin DSRyan PSonntag VWestmark RWidmayer MA: A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogenetic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine 28:121912252003

    • Search Google Scholar
    • Export Citation
  • 4

    Bishop RCMoore KAHadley MN: Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:2062101996

    • Search Google Scholar
    • Export Citation
  • 5

    Boakye MMummaneni PVGarrett MRodts GHaid R: Anterior cervical discectomy and fusion involving a polyetheretherketone spacer and bone morphogenetic protein. J Neurosurg Spine 2:5215252005

    • Search Google Scholar
    • Export Citation
  • 6

    Brown MDMalinin TIDavis PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop Relat Res 119:2312361976

    • Search Google Scholar
    • Export Citation
  • 7

    Cauthen JCTheis RPAllen AT: Anterior cervical fusion: a comparison of cage, dowel and dowel-plate constructs. Spine J 3:1061172003

    • Search Google Scholar
    • Export Citation
  • 8

    Celik SEKara ACelik S: A comparison of changes over time in cervical foraminal height after tricortical iliac graft or polyetheretherketone cage placement following anterior discectomy. J Neurosurg Spine 6:10162007

    • Search Google Scholar
    • Export Citation
  • 9

    Cho DYLee WYSheu PC: Treatment of multilevel cervical fusion with cages. Surg Neurol 62:3783862004

  • 10

    Cho DYLee WYSheu PCChen CC: Cage containing a biphasic calcium phosphate ceramic (Triosite) for the treatment of cervical spondylosis. Surg Neurol 63:4975042005

    • Search Google Scholar
    • Export Citation
  • 11

    Deutsch HHaid RRodts G JrMummaneni PV: The decision-making process: allograft versus autograft. Neurosurgery 60:1 SupplS98S1022007

    • Search Google Scholar
    • Export Citation
  • 12

    Floyd TOhnmeiss D: A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 9:3984032000

  • 13

    Goldberg VMStevenson S: Natural history of autografts and allografts. Clin Orthop Relat Res 255:7161987

  • 14

    Gore DR: Technique of cervical interbody fusion. Clin Orthop Relat Res 188:1911951984

  • 15

    Gore DRSepic SB: Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:6676711984

    • Search Google Scholar
    • Export Citation
  • 16

    Hacker RJ: A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg 93:2222262000

    • Search Google Scholar
    • Export Citation
  • 17

    Hacker RJCauthen JCGilbert TJGriffith SL: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:264626552000

    • Search Google Scholar
    • Export Citation
  • 18

    Heary RFSchlenk RPSacchieri TABarone DBrotea C: Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 50:5105172002

    • Search Google Scholar
    • Export Citation
  • 19

    Jacobs WCAnderson PGLimbeek JWillems PCPavlov P: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev 4:CD0049582004

    • Search Google Scholar
    • Export Citation
  • 20

    Lanman THHopkins TJ: Early findings in a pilot study of anterior cervical interbody fusion in which recombinant human bone morphogenetic protein-2 was used with poly(L-lactideco-D,L-lactide) bioabsorbable implants. Neurosurg Focus 16:3E62004

    • Search Google Scholar
    • Export Citation
  • 21

    Lofgren HJohannsson VOlsson TRyd LLevander B: Rigid fusion after Cloward operation for cervical disc disease using autograft, allograft, or xenograft: a randomized study with radiostereometric and clinical follow-up assessment. Spine 25:190819162000

    • Search Google Scholar
    • Export Citation
  • 22

    Madawi AAPowell MCrockard HA: Biocompatible osteoconductive polymer versus iliac graft. A prospective comparative study for the evaluation of fusion pattern after anterior cervical discectomy. Spine 21:212321301996

    • Search Google Scholar
    • Export Citation
  • 23

    Malloy KMHilibrand AS: Autograft versus allograft in degenerative cervical disease. Clin Orthop Relat Res 394:27382002

  • 24

    Martin GJ JrHaid RW JrMacMillan MRodts GE JrBerkman R: Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine 24:8528591999

    • Search Google Scholar
    • Export Citation
  • 25

    Mastronardi LDucati AFerrante L: Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien) 148:3073122006

    • Search Google Scholar
    • Export Citation
  • 26

    McConnell JRFreeman BJDebnath UKGrevitt MPPrince HGWebb JK: A prospective randomized comparison of coralline hydroxyapatite with autograft in cervical interbody fusion. Spine 28:3173232003

    • Search Google Scholar
    • Export Citation
  • 27

    McGuire RASt John K: Comparison of anterior cervical fusions using autogenous bone graft obtained from the cervical vertebrae to the modified Smith-Robinson technique. J Spinal Disord 7:4995031994

    • Search Google Scholar
    • Export Citation
  • 28

    Peolsson AVavruch LHedlund R: Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine. Eur Spine J 16:1731782006

    • Search Google Scholar
    • Export Citation
  • 29

    Rawlinson JN: Morbidity after anterior cervical decompression and fusion. The influence of the donor site on recovery, and the results of a trial of surgibone compared with autologous bone. Acta Neurochir (Wien) 131:1061181994

    • Search Google Scholar
    • Export Citation
  • 30

    Ryu SIMitchell MKim DH: A prospective randomized study comparing a cervical carbon fiber cage to the Smith-Robinson technique with allograft and plating: up to 24 months follow-up. Eur Spine J 15:1571642006

    • Search Google Scholar
    • Export Citation
  • 31

    Sawin PDTraynelis VCMenezes AH: A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg 88:2552651998

    • Search Google Scholar
    • Export Citation
  • 32

    Schroder JGrosse-Dresselhaus FSchul CWassmann H: PMMA versus titanium cage after anterior cervical discectomy - a prospective randomized trial. Zentralbl Neurochir 68:272007

    • Search Google Scholar
    • Export Citation
  • 33

    Shamsaldin MMouchaty HDesogus NCostagliola CDi Lorenzo N: Evaluation of donor site pain after anterior iliac crest harvesting for cervical fusion: a prospective study on 50 patients. Acta Neurochir (Wien) 148:107110742006

    • Search Google Scholar
    • Export Citation
  • 34

    Shields LBRaque GHGlassman SDCampbell MVitaz THarpring J: Adverse effects associated with high-dose recombinant human bone morphogenetic protein-2 use in anterior cervical spine fusion. Spine 31:5425472006

    • Search Google Scholar
    • Export Citation
  • 35

    Smucker JDRhee JMSingh KYoon STHeller JG: Increased swelling complications associated with off-label usage of rh-BMP-2 in the anterior cervical spine. Spine 31:281328192006

    • Search Google Scholar
    • Export Citation
  • 36

    Suchomel PBarsa PBuchvald PSvobodnik AVanickova E: Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern. Eur Spine J 13:5105152004

    • Search Google Scholar
    • Export Citation
  • 37

    Thome CKrauss JKZevgaridis D: A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev 27:34412004

    • Search Google Scholar
    • Export Citation
  • 38

    Thome CLeheta OKrauss JKZevgaridis D: A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in patients undergoing anterior cervical discectomy. J Neurosurg Spine 4:192006

    • Search Google Scholar
    • Export Citation
  • 39

    van den Bent MJOosting JWouda EJvan Acker REAnsink BJBraakman R: Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine 21:8348401996

    • Search Google Scholar
    • Export Citation
  • 40

    van Limbeek JJacobs WCAnderson PGPavlov PW: A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J 9:1291362000

    • Search Google Scholar
    • Export Citation
  • 41

    Vavruch LHedlund RJavid DLeszniewski WShalabi A: A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine 27:169417012002

    • Search Google Scholar
    • Export Citation
  • 42

    Wigfield CCNelson RJ: Nonautologous interbody fusion materials in cervical spine surgery: how strong is the evidence to justify their use?. Spine 26:6876942001

    • Search Google Scholar
    • Export Citation
  • 43

    Young WFRosenwasser RH: An early comparative analysis of the use of fibular allograft versus autologous iliac crest graft for interbody fusion after anterior cervical discectomy. Spine 18:112311241993

    • Search Google Scholar
    • Export Citation
  • 44

    Zdeblick TADucker TB: The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:7267291991

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 196 196 13
Full Text Views 117 117 2
PDF Downloads 155 155 1
EPUB Downloads 0 0 0

PubMed

Google Scholar