Introduction: Variations exist in methodology for performing anterior cervical discectomy and fusion (ACDF), particularly with respect to bone graft material and the use of osteobiologic fusion enhancing adjuvants. Currently, the use of autologous iliac crest bone graft remains the gold standard, despite procurement-associated donor site morbidities. Allograft provides osteoconductive scaffolding, but on its own lacks the osteogenic and osteoinductive qualities of autograft. We aimed to discover whether cadaveric bone allografts in conjunction with autogenous iliac crest bone marrow aspirate provided comparable clinical and radiographic outcomes for patients undergoing ACDF with autologous iliac crest bone grafting.

Methods: Two hundred and sixty-four cases of single or multilevel anterior cervical discectomy and fusion with freeze dried cadaveric allograft and autogenous bone marrow aspirate were retrospectively reviewed. Eighty-four total patients met inclusion criteria of a minimum 1 year follow-up and no prior history of spine surgery. Anterior cervical plating was used in all cases. Clinical outcomes were assessed using Visual Analog Scale scores given to patients preoperatively and at each postoperative follow up visit. Radiographic fusion was assessed using plain flexion-extension radiography.

Results: Preliminary data suggests that allograft infused with iliac crest bone marrow aspirate yields clinically successful arthrodesis rates of 92% for single level and 91% multi-level ACDF.

Conclusions: High rates of successful arthrodesis demonstrate the potential for cadaveric allograft infused with autologous bone marrow as an acceptable alternative to harvesting autograft for single and multilevel ACDF. The results of our study suggest that further prospective studies are warranted to assess the viability of this treatment modality in patients undergoing ACDF.

Patient Care: We provide the first set of data demonstrating the success of cadaveric allograft infused with bone marrow aspirate in ACDF in hopes of highlighting the importance of elucidating a treatment methodology for single and multi-level ACDF which is effective in terms of achieving successful arthrodesis, minimizing perioperative and postoperative morbidity and maximizing long term clinical outcome for patients.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the relative risks and benefits of using autologous and allogenic bone grafts in spinal fusion. 2) Discuss the potential utility of utilizing cadaveric allogenic grafts with autologous bone marrow aspirate for ACDF. 3) Recognize the significance of procuring a bone graft substrate that provides high rates of clinical and radiographic fusion while minimizing the patient's perioperative and postoperative morbidity.

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