Introduction: Since 1991 we have performed anterior cervical fusions using cortical allografts filled with demineralized bone matrix(DBM) with locking plates and first reported in 1996 that this significantly improved fusion rate and lessened complications. this technique has become widely used. we report long term followup on 419 consecutive patients operated between Jan 1, 1991 and July 30, 2006.

Methods: The senior author has maintained a data base since Jan 1, 1991. Retrospective analysis with chi square analysis.

Results: 361 of the 419(86%)had long term follow up(mean 11.6 years). 226 were performed for radiculopathy and 193 for myeloradiculopathy. There was zero new radiographic plate breakage, no new pseudoarthrosis, graft collapse or subsidence after the one year analysis. Arm pain scores(mean 18), SF- 36 Physical(mean 49.1) and motor remained improved in 99% of the radiculopathy patients and 92% of the myeloradiculopathy patients. New radiographic spondylotic changes at other levels occurred in 122/361 (34%) including 62/231(27%) single level fusions and 60/130(46%) multi-level fusions(p<0.05). 86/122(70%) smoked tobacco compared to 36/239(15%) with no new findings which was significant(p<0.02). All of the new spondylosis patients had increased neck pain scores(mean 54) and 20(5.5 %) had a new radiculopathy or myeloradiculopathy that lead to a second ACD fusion. The distribution of new changes was 38% adjacent segment above the fusion, 38% both above and below, 18% adjacent below, and 4% non-adjacent.

Conclusions: Cortical allograft/DBM/locking plate fusion is durable clinically and radiographically with no long term complications. The rate of adjacent level disease appears similar to previous reports. Tobacco smoking and multi-level fusion significantly increased adjacent level disease.

Patient Care: The results of this technique provide the best long term atnerior cervical fusion results with the fewest complications.

Learning Objectives: That the cortical allograft/locking plate/demineralized bone matrix anterior cervical fusion provides the best results for anterior cervical fusions.

References: SShapiro:Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy