Techniques for cervical interbody grafting

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p></jats:sec>

Cervical Interbody Fusion Is Enhanced by Allogeneic Mesenchymal Precursor Cells in an Ovine Model

“…36 Currently, it is unclear from the literature if these osteoconductive carriers result in fusions rates equivalent to autograft . [37][38][39] Recombinant bone morphogenetic proteins have been used as an additive osteoinductive agent to promote fusion. 40,41 There are, however, reports of adverse effects of their use in the cervical spine.…”

Operative Outcomes for Cervical Myelopathy and Radiculopathy

“…However, their use comes with potential problems, including risk of infections and graft rejection, higher rates of collapse and nonunion, especially in multilevel fusions, and prolonged period required for graft incorporation [46]. Ryken et al in a comprehensive review concluded that there appears to be equivalency regarding the use of harvested autogenous bone graft, allograft, polyetheretherketone, and titanium cages in anterior fusion [53]. …”

Autologous clavicle bone graft for anterior cervical discectomy and fusion with titanium interbody cage

“…The iliac crest has long been recognized among many spine surgeons as a reliable source for cancellous bone. 1,8,13 However, the iliac crest is not an ideal donor site, because a variety of donorsite morbidities can result from its use. 2,7,12,[15][16][17] This has led to the search for other autologous donor sites.…”