Mesh Cage Reconstruction With Autologous Cancellous Graft in Anterior Cervical Discectomy and Fusion

Abstract

Retrospective case series. To present the technique and results of anterior cervical discectomy and fusion (ACDF) by using mesh cage reconstruction with autologous cancellous bone graft. Since the initial ACDF description by Bailey and Badgley, a variety of grafting techniques have been proposed. The primary disadvantage of autologous bone grafting is donor site pain when compared with allograft. However, autologous bone graft still remains the standard and cancellous bone retrieval through a cortical window minimizes subperiosteal stripping. This may improve donor site morbidity while providing the advantages of autologous bone graft. Thirty-seven patients who had undergone ACDF with cancellous bone graft by using mesh cages and anterior plating with at least 6 months follow-up were reviewed. All patients had autologous cancellous bone graft harvested through a cortical window with limited subperiosteal striping. Bone graft was then packed into and around a titanium mesh cage that furnishes structural support. The principal diagnosis was radiculopathy in 30 patients, myeloradiculopathy in 2 patients, instability in 3 patients, and kyphosis in 2 patients. Sixty-four levels were fused: one 4-level fusion, eight 3-level fusions, eight 2-level fusions, and twenty 1-level fusions. All patients demonstrated improved neurologic function and resolution of preoperative pain postoperatively. The donor site for cancellous bone was the iliac crest in 33 patients and the manubrium in 4 patients. Perioperative donor site pain was absent in 35 of 38 patients by 6 weeks with resolution of donor site pain by 3 months in all patients. At most recent follow-up, no patients had donor site pain, no instrumentation failure, and no wound complications. Sixty-three of 64 (98.4%) of cervical segments fused. One pseudoarthrosis occurred in an attempted 4-level fusion, which fused after a second operation. Autologous bone grafting with mesh cage reconstruction is an acceptable alternative to autologous tricortical structural graft or allograft with reduced donor site pain and excellent biologic arthrodesis.