Use of the clavicle in anterior cervical discectomy/corpectomy fusion procedures: cadaveric feasibility study

Abstract

Graft sources for cervical fusion procedures include synthetic materials, donor grafts, and autologous bones such as the iliac crest. Considering the data that autologous bone grafts seem to generate the best results for fusion, the next logical step is to seek alternative donor sites so as to attempt to reduce the morbidity associated with these procedures. To our knowledge, autologous clavicle has not been explored as a potential source for cervical fusion. Therefore, the following study was performed to verify the utility of this bone for these procedures. Seven adult cadavers were used for this study. In the supine position, a standard surgical approach and dissection to the anterior cervical spine were performed. Specimens underwent a standard discectomy or corpectomy with placement of harvested ipsilateral clavicle previously dissected. An anterior cervical plating system was next placed over these sites using standard techniques. Measurements of the harvested clavicle were made. The results of our morphometric analysis were as follows: An average of 5 cm of bone was easily removed from the middle one third of the clavicle. No gross injury was found to vicinal neurovascular structures. The middle one third of the clavicle offered sufficient bone for the one to two segments fused in our study with remaining bone for at least two additional segments. The mean diameter of this part of the clavicle was 1.2 cm. Based on our cadaveric study, such a bony substitute as autologous clavicle might be a reasonable alternative to the iliac crest for use in anterior cervical fusion procedures.