Introduction: Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are widely used procedures for the treatment of myelopathy and radiculopathy. High fusion rates have been reported using various graft materials, including allograft, bone morphogenic proteins, and iliac crest autograft. While iliac crest autograft remains the gold standard, many surgeons have transitioned to alternative graft materials to avoid harvesting through a separate incision. Local autograft harvested from the operative site provides a promising and cost effective alternative. We present a series of patients undergoing single and multi-level ACDF and ACCF using local autograft only.
Methods: Between 2004 and 2009, 80 patients (33 males, 47 females; mean age 52.23 yo [range, 21-78 years]) who underwent ACDF (41.25%), ACCF (47.5%), or combination ACDF/ACCF (11.25%) to treat cervical spondylosis, deformity, or trauma were enrolled. Patient data was investigated retrospectively, documenting: radiograph-confirmed anterior interbody fusion, postoperative clinical improvement, patient comorbidities, time to last follow-up, and complication rates. Interbody fusion and postoperative clinical improvement were the primary endpoints used.
Results: Radiographic fusion was seen in 97.5% of patients and postoperative clinical improvement was recorded in 80% of cases. The majority of patients were treated for myelopathy (81.25%). The perioperative complication rate was 7.5%, with incidental durotomy accounting for four out of six perioperative complications. One of the four incidental durotomies resulted in CSF leak.
Conclusions: In this series, a fusion rate of 97.5% was achieved using reconstruction with PEEK cages packed with local autograft only. Acceptable fusion rate was achieved despite risk factors known to decrease fusion rates, including smoking (21.25%), aspirin and/or steroid use (19.74%), and diabetes mellitus (10%). Many of the operations were revisions (21.25%), multilevel reconstructions (80%) and corpectomy (58.75%). We believe local autograft only is an acceptable choice for bone graft material during anterior cervical decompression and fusion.
Patient Care: We hope that the results of our case series show that using only local autograft in ACDFs/ACCFs is a cost effective method while not sacrificing fusion rates and good clinical outcomes. Using only local autograft also spares an additional surgical incision as compared to using iliac crest autograft.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) discuss the effectiveness of using only local autograft in ACDFs/ACCFs, and 2) identify the advantages of using only local autograft as compared to iliac crest autograft.