Carbon fibre cage vs. autograft for anterior cervical discectomy and interbody fusion: graft morbidity and clinical outcome

ABSTRACT

We performed a study to evaluate and compare the clinical outcome following anterior cervical discectomy and interbody fusion [ACDF] with either carbon fibre cage [CFC] implant or iliac crest autograft for cervical spondylotic patients. A retrospective review of 66 consecutive patients [30 in the autograft group and 36 in the CFC group] who underwent ACDF for cervical spondylotic radiculopathy, myelopathy, or both at one or two levels over a 4 year period from 1999-2002. We evaluated clinical outcome including symptomatic relief, operative morbidity and length of stay in each group. Postal questionnaires were sent to all patients to assess their clinical outcome [one year minimum follow-up] Neck Disability Index [NDI] was slightly better in the CFC group [man 16.42, SD 10.24] compared to autograft group [mean 19.9, SD 14], the difference was statistically insignificant [p>0.2]. Patient's self-rating of overall functions in the CFC group were better in 73% of patients, same in 21% and worse in 6% compared to better in 55%, same in 27%, and worse in 18% in the autograft group [p>0.2]. Arm pain rating were better in 70%, same in 24%, and worse in 6% [CFC group] compared to better in 59%,s ame in 26%, and worse in 14% [autograft group] [p>0.2]. There was a significant rate of long-term donor site pain in the autograft group [mild pain at the time of answering in 54.5% of patients]. There was one graft-related complication in each group. In the radiculopathic patients [19 autograft, 20 CFC] the difference in length of stay was significant [autograft; mean 4.1, median 4 vs. CFC; mean 3.75 median 3] [p=0.050]. Autograft and CFC implants for anterior cervical discectomy and interbody fusion are both safe and effective. No significant differences were found in the long-term clinical outcomes. The use of CFC implant however, can avoid donor site pain and achieve a shorter hospital stay