A New Source of Structural Autograft for ACDF Surgery: Cervical Laminae

Abstract

Background Autograft bone as a fusion substrate is still the gold standard in the procedure. However, few studies have reported that using autologous cervical laminae as the bone graft in ACDF during the combined posteroanterior cervical spine surgery. Objective This study aims to evaluate the feasibility of using autologous cervical laminae as the bone graft in ACDF and to describe the clinical and radiographic outcomes in patients undergoing combined posteroanterior cervical surgery using autologous laminae as bone graft in ACDF. Material and Methods Computed tomography (CT) scan of the cervical spine were performed in 50 adult cases. The heights of the laminae and the middle intervertebral space from C3 to C7 were measured on the CT planes. Then, 16 patients (nine males and seven females) with cervical spondylotic myelopathy underwent one-level combined posteroanterior procedure with anterior plate fixation from January 2010 to January 2013. Patients underwent combined posteroanterior surgery with laminectomy and ACDF. The structural laminae obtained from laminectomy were used as bone graft in ACDF. The clinical and radiographic outcomes of the patients were analyzed and the effectiveness and safety of the surgery was evaluated. Results The average height of the laminae and the middle intervertebral space from C3 to C7 were 11.18 ± 1.05 mm and the 5.75 ± 0.58 mm, respectively. Statistical significant difference was found between the heights of the laminae and the space ( p < 0.001). All the patients were followed up and the average follow-up period was 25.5 ± 3.1 months. All patients had immediate postoperative resolution of symptoms and radiographic evidence of solid fusion 3 months later. Postoperatively, excellent results were reported in 62.5%, good results in 18.8%, and fair results in 18.8% of the patients according to Odom criteria. Visual analog scale score of the neck and extremities pain was significantly decreased after the surgery ( p = 0.014). The average preoperative and postoperative lordosis angles of the cervical spine were 24.42 ± 13.84 degrees and 32.91 ± 7.79 degrees, and the difference was significant ( p < 0.01). Little loss of the angle was noted at final follow-up (32.91 ± 7.79 vs. 29.30 ± 7.88 degrees, p = 0.51). Anterior intervertebral space height was significantly increased ( p < 0.001) after the surgery and a little declined at final follow-up ( p = 0.43). No intraoperative complication was noted in the patients and three patients got self-limiting dysphagia postoperatively, who recovered spontaneously. Conclusion The height of the cervical laminae is adequate for bone graft in ACDF. Structural autograft harvested from the laminae provides a viable alternative to AIC grafting.