COMPARISON OF TRICORTICAL AUTOGRAFT TO ARTIFICIAL BONE GRAFT IN ANTERIOR CERVICAL DISCECTOMY AND FUSION WITH RIGID PLATE FIXATION

Dr VINOD GAUTAM; Dr MANISH DIWAKAR; Dr SAGAR HANSALIA; Dr GAURAV KALARIYA; Dr NITIN DARGAR

Volume : IV, Issue : X, October - 2014

COMPARISON OF TRICORTICAL AUTOGRAFT TO ARTIFICIAL BONE GRAFT IN ANTERIOR CERVICAL DISCECTOMY AND FUSION WITH RIGID PLATE FIXATION

Dr Vinod Gautam, Dr Manish Diwakar, Dr Sagar Hansalia, Dr Gaurav Kalariya, Dr Nitin Dargar

Abstract :

Introduction : Anterior cervical discectomy and fusion (ACDF) has become an accepted procedure for decompression of neural elements and spinal stabilization in the treatment of degenerative disease, trauma, tumors and cervical tuberculosis. Selection of appropriate graft substrate to optimize fusion rate and healing is essential. The present study was undertaken to determine the effectiveness of artificial graft versus tricortical autograft in fusion and clinical outcome. Materials and methods: A retrospective radiographic and clinical review to assess fusion and clinical outcome in thirty patients who underwent ACDF with anterior plating between April 2011 and Jan 2013 at our hospital, were included in the study. Sixteen patients (53%) had autogenous tricortical iliac crest bone graft and fourteen patients(47%) received artificial (tricalcium phosphate) bone graft. Follow up lateral neutral, flexion and extension radiographs were used to assess fusion at six months . The radiographs were reviewed by an independent blinded observer in assessing fusion as per Bridwell criteria. Clinical outcome were rated excellent, good, fair and poor based on Odom’s criteria. Results: Radiographic fusion was assessed in all patients and it was found that 70% patients of autogenous bone graft had grade 1 fusion compared to 56% in artificial group. In contrast 8% patients had grade 4 fusion in artificial group compared to none in autogenous group. Clinical outcome was excellent in 53% patients. Conclusion: A high fusion rate (64%) was obtained for ACDF with plating with either autograft or artificial graft. In the study, grade 4 fusion occurred in one patient with artificial graft but this was not significant. Excellent and good clinical outcome was noted in 76% patients. Proper patient selection and meticulous operative technique is essential to obtain high fusion rates and optimal clinical outcome which is equally important as graft type.