The purpose of this prospective semi-randomised comparative study was to compare fusion rates, course of fusion, and occurrence of collapse and subsidence of autologous and allogenic bone grafts in instrumented anterior cervical fusion. The number of fused levels and the smoking status were investigated as potential factors influencing the bone-healing process. No similar prospective study on instrumented anterior cervical discectomy and fusion was found in the literature.
Seventy-nine consecutive patients were operated on using the Smith–Robinson technique with a single instrumentation system at one or two levels. Seventy-six cadaverous fibular bone grafts and 37 autologous iliac-crest bone grafts were inserted. All patients were followed up for at least 2 years.
The radiographs obtained during the follow-up were analysed, and showed no statistical difference in fusion and collapse rate between autografts and allografts. Allografts showed significantly longer time to union. No case of graft migration was observed. No difference was found between fusion and collapse rate with respect to the number of fused levels in general, but greater time to union was seen in two-level fusions. When one- and two-level subgroups were compared, there was no evidence of any significant difference in fusion or collapse rates between autografts and allografts, and the healing process took longer in allogenic grafts. Smoking status did not alter any of the fusion or collapse rates, or the course of bone fusion.
This study demonstrates that allografts are suitable substitutes for autografts in instrumented ACDF. Prolonged time to union observed in allogenic bone grafts does not seem to be an important factor in instrumented procedures. Two-level grafting does not imply a significantly lower fusion rate, but longer time to union can be expected than with single-level instrumented procedures in both allograft and autograft subgroups. Our relatively small number of patients may not have been sufficient to decipher significant differences between smokers and non-smokers in the rate or course of fusion as previously reported.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
An HS, Simpson JM, Glover JM, Stephany J (1995) Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 20:2211–2216
Aronson N, Fitzer DL, Bagan M (1968) Anterior cervical fusion by the Smith–Robinson approach. J Neurosurg 29:396–404
Bishop RC, Moore KA, Hadley MN (1996) Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:206–210
Bohlman HH, Emery SE, Goodfellow DB, Jones PK (1993) Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:1298–1307
Brodsky AE, Khalil MA, Sassard WR, Newman BP (1992) Repair of symptomatic pseudoarthrosis of anterior cervical fusion. Posterior versus anterior repair. Spine 17:1137–1143
Brown CW, Orme TJ, Richardson HD (1986) The rate of pseudoarthrosis (surgical nonunion) in patients who are smokers and patients who are nonsmokers: a comparison study. Spine 11:942–943
Brown MD, Malinin TI, Davis PB (1976) A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:231–236
Cloward RB (1958) The anterior approach for removal of ruptured cervical disc. J Neurosurg 15:602–617
Cloward RB (1980) Gas-sterilized cadaver bone grafts for spinal fusion operations. A simplified bone bank. Spine 5:4-10
Conolly ES, Seymour R, Adams JE (1965) Clinical evaluation of anterior cervical fusion for degenerative disc disease. J Neurosurg 23:431–437
Daftari TK, Whitesides TE Jr, Heller JG, Goodrich AC, McCarey BE, Hutton WC (1994) Nicotine on the revascularization of bone graft. An experimental study in rabbits. Spine 19:904–911
DePalma AF, Rothman RH, Lewinnek GE, Canale ST (1972) Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:755–758
Erbe EM, Marx JG, Clineff TD, Bellincampi LD (2001) Potential of an ultraporous beta-tricalcium phosphate synthetic cancellous bone void filler and bone marrow aspirate composite graft. Eur Spine J 10:S141–146
Farey ID, McAfee PC, Davis RF, Long DM (1990) Pseudoarthrosis of the cervical spine after anterior arthrodesis. Treatment by posterior nerve-root decompression, stabilization and arthrodesis. J Bone Joint Surg Am 72:1171–1177
Floyd T, Ohnmeiss D (2000) A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 9:398–403
Gore DR, Sepic SB (1984) Anterior cervical fusion for degenerated or protruded disc. A review of one hundred forty-six patients. Spine 9:667–671
Hanley EN Jr, Levy JA (1989) Surgical treatment of isthmic lumbosacral spondylolisthesis. Analysis of variables influencing results. Spine 14:48–50
Hilibrand AS, Fye SE, Emery SE, Palumbo MA, Bohlman HH (2001) Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 83-A:668–673
Khan SN, Sama A, Sandhu HS (2001) Bone graft substitutes in spine surgery. Curr Opin Orthop 12:216–222
Lind M, Bunger C (2001) Factors stimulating bone formation. Eur Spine J 10:S102–109
Marchesi DG (2000) Spinal fusion: bone and bone substitutes. Eur Spine J 9:372–378
Martin GJ Jr, Haid RW Jr, MacMillan M, Rodts GE Jr, Berkman R (1999) Anterior cervical discectomy with freeze-dried fibula allograft. Overview of 317 cases and literature review. Spine 24:852–858
Newman M (1993) The outcome of pseudoarthrosis after cervical anterior fusion. Spine 18:2380–2382
Nolte PA, van der Krans, Patka P, Janssen IM, Ryaby JP, Albers GH (2001) Low-intensity pulsed ultrasound in the treatment of nonunions. J Trauma 51:693–702
Pitzen T, Wilke HJ, Caspar W, Claes L, Steudel WI (1999) Evaluation of a new monocortical screw for anterior cervical fusion and plating by a combined biomechanical and clinical study. Eur Spine J 8:382–387
Riley LH Jr, Robinson RA, Johnson KA, Walker AE (1969) The results of anterior interbody fusion of the cervical spine: review of ninety-three consecutive cases. J Neurosurg 30:127–133
Rish BL, McFadden JT, Penix JO (1976) Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5:119–121
Robinson RA, Smith GW (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hospital 96:223–224
Robinson RA, Walker AE, Ferlic DC, Wiecking DK (1962) The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg Am 44:1569–1587
Shapiro S (1996) Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy. J Neurosurg 84:161–165
Silcox DH, Daftari T, Boden SD, Schimandle JH, Hutton WC, Whitesides TE Jr (1995) The effect of nicotine on spinal fusion. Spine 20:1549–1553
Sonntag VK, Han PP, Vishteh AG (2001) Anterior cervical discectomy. Neurosurgery 49(4):909–912
Vernejoul MC de, Bielakoff J, Herve M, Gueris J, Hott M, Modrowski D, Kuntz D, Miravet L, Ryckewaert A (1983) Evidence for defective osteoblastic function. A role for alcohol and tobacco consumption in osteoporosis in middle-aged men. Clin Orthop 179:107–115
Wang JC, McDonough PW, Endow KK, Delamarter RB (2001) A comparison of fusion rates between single level cervical corpectomy and two level discectomy and fusion. J Spinal Disord 14:222–225
Wang JC, McDonough PW, Kanim LE, Endow KK, Delamarter RB (2001) Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion. Spine 15; 26(6):643–646
White AA, Southwick WO, Deponte RJ, Gainor JW, Hardy R (1973) Relief of pain by anterior cervical spine fusion for spondylosis. A report of sixty-five patients. J Bone Joint Surg Am 55:525–534
Whitecloud TS, LaRocca SH (1976) Fibular strut graft in reconstructive surgery of the cervical spine. Spine 1:33–43
Williams JL, Allen MB Jr, Harkess JW (1968) Late results of cervical discectomy and interbody fusion: some factors influencing the results. J Bone Joint Surg Am 50:277–286
Yonenobu K, Fuji T, Ono K, Okada K, Yamomoto T, Harada N (1985) Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:710–716
Yoon ST (2001) Cytokines and gene therapy in spine fusion and its potential in cervical fusion. Curr Opin Orthop 12:251–256
Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:726–727
The study was supported by the Czech Ministry of Health, grant no. ND/6892-3.
About this article
Cite this article
Suchomel, P., Barsa, P., Buchvald, P. et al. Autologous versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern. Eur Spine J 13, 510–515 (2004). https://doi.org/10.1007/s00586-003-0667-z
- Anterior cervical spine fusion
- Internal fixation
- Autologous bone graft
- Allogenic bone graft
- Cigarette smoking