Abstract :
Anterior cervical decompression and fusion has been widely accepted for cervical disc disease and bony disease affecting the spinal canal. There has been controversy regarding whether fusion with autologous bone or allograft is most appropriate. A retrospective analysis of our experience from 5/22/90 to 7/26/95 is presented. 335 patients underwent anterior cervical diskectomy and/or corpectomy involving 559 disc levels with fusion performed by fibular allograft augmented with autologous bone dust using a modified Caspar technique. Indications for surgery were hemiated cervical disc and/or spondylotic spurs with intractable cervical radiculopathy or myelopathy. Spondylotic spurs and bone chips obtained in performing the decompression, foraminotomy and partial drilling of the end plates were saved and placed in the center of a reconstituted fibular allograft. Solvent preserved dehydrated fibular strut graft was used in the majority of allograft cases. Indications for anterior cervical instrumentation were preoperative horizontal subluxation and posterior splay, more than 2 disc levels completed simultaneously, or revision of a previous anterior cervical diskectomy and fusion. Postoperatively the patients were immobilized in a cervical collar for at least 6 weeks. In the initial portion of the study before the unicortical anterior cervical plates were available, 9 patients were placed in a halo. Over 80% of the patients showed signs of radiologic fusion at 6 weeks, and the cervical collar could be discontinued. Anterior cervical instrumentation was performed in 72 patients. No patient demonstrated anterior or posterior graft extrusion or deep wound infection. Successful fusion was obtained in 98% of the patients. 6 patients required revision surgery consisting of either posterior fusion or revision surgery because of problems with anterior cervical plating. It was common to see settling, especially in osteoporotic patients, which is described as protrusion of bone graft into the adjacent vertebral body in an initially progressive manner seen from the initial x-ray. However, this was not seen to be detrimental. No patient developed intractable radicular syndrome or severe malalignment from settling. It was felt that settling may be of benefit in securing the bone graft. No patients have been lost to follow-up, and all patients had at least 1 year follow-up. To promote early incorporation and prevent delayed failure, autologous bone from the operative site as an adjunct to the use of fibular allograft appears to benefit fusion
