Abstract
PurposeTo investigate the efficacy and safety of allograft and hydroxyapatite (HA) as substitutes for autograft in anterior cervical discectomy and fusion (ACDF).MethodsIn this study, 49 patients (80 segments) treated with ACDF were included and allocated into three groups [group A, autogenous iliac bone, n = 18; group B, allogeneic bone, n = 16; group C, HA, n = 15]. The clinical efficacy and fusion status were compared among each group. Complications were recorded in detail, and the Bazaz classification and Voice Handicap Index-10 (VHI-10) were used to detect dysphagia and dysphonia.ResultsPatients exhibited similar clinical efficacy among the groups during the final follow-up. All patients in groups A and B achieved fusion compared to only 73.3% of patients in group C. Groups A and B had similar fusion score, both of which greater than that of group C. No cage subsidence was observed in group A; however, 6.3% of patients in group B and 53.3% in group C had cage subsidence. Two patients in group A (11.1%) had persistent pain at the donor site. One patient in group B had dysphagia and dysphonia (6.3%), while one patient in group C had dysphonia (6.7%).ConclusionIn ACDF, the autogenous iliac bone was the most ideal bone graft. The allogeneic bone was an acceptable substitute but risked cage subsidence and dysphagia. HA had a much lower fusion rate and a high risk of cage subsidence. Better substitutes should be further explored for ACDF.
Highlights
Cervical spondylopathy is one of the most common degenerative diseases
Available substitutes for autogenous iliac bone could be divided into allograft, xenograft, synthetic graft, and growth factor products are widely used [6]
Patient satisfaction was evaluated using the Odom standard [24]: excellent, no symptoms related to cervical disease and able to perform daily activities without limitations; good, moderate symptoms related to cervical disease and able to perform daily activities without significant limitations; satisfactory, slight improvement in symptoms related to cervical disease and significant limitations in daily activities; poor, no improvement in, or aggravation of, symptoms related to cervical disease and not able to perform daily activities (Table 1)
Summary
Cervical spondylopathy is one of the most common degenerative diseases. Anterior cervical discectomy and fusion (ACDF) is an effective and safe surgical treatment for this disorder. The autologous iliac bone was previously considered to be the most ideal bone graft in ACDF due to its osteogenic, osteoconductive, and osteoinductive properties. Exploring adequate substitutes for autogenous iliac bone remains an issue [1,2,3,4,5]. Available substitutes for autogenous iliac bone could be divided into allograft (cancellous allografts, cortical allografts, demineralized bone matrix), xenograft, synthetic graft (calcium sulfate, calcium phosphate ceramics [hydroxyapatites, tricalcium phosphate, biphasic calcium phosphate], calcium phosphate cements, bioactive glass), and growth factor products (bone morphogenetic proteins [BMPs], platelet-rich plasma [PRP]) are widely used [6]. Xenograft has been scarcely reported and BMP is usually used in combination with other bone grafts. Due to its chemical similarity with natural bone as well as its good biocompatibility and osteoconduction [17], hydroxyapatite may serve as an ideal bone graft substitute. A prospective, matched, and controlled study had to be discontinued early due to a high rate of resorption in the Chitra-HA graft (0% fusion rate) [23]
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