title: Comparison of the biomechanical stability of dense cancellous allograft with tricortical iliac autograft and fibular allograft for cervical interbody fusion.
abstract: Several choices are available for cervical interbody fusion after anterior cervical discectomy. A recent option is dense cancellous allograft (CS) which is characterized by an open-matrix structure that may promote vascularization and cellular penetration during early osseous integration. However, the biomechanical stability of CS should be comparable to that of the tricortical iliac autograft (AG) and fibular allograft (FA) to be an acceptable alternative to these materials. The purpose of this study was to compare the initial biomechanical stability of CS to that of AG and FA in a one-level anterior cervical discectomy and interbody fusion (ACDF) model. Twelve human cervical spines (C3-T1) were loaded in six modes of motion and evaluated under three conditions: (1) intact, (2) after ACDF using CS, AG, and FA in alternating sequences, and (3) after ACDF with anterior plating. Three reflective markers were placed on the adjacent vertebral bodies. Intervertebral motion was measured with a video-based motion-capture system (MacReflex, Qualisys, Sweden). Torques were applied to a maximum of 2.0 N m. The range-of-motion and neutral-zone values measured in each loading mode were compared. No graft material displayed significant differences in biomechanical stability in any of the tested loading modes, suggesting that the initial stability of CS is comparable to that of AG and FA. Anterior cervical plating significantly increased biomechanical stability in all modes.
authors.affiliation: Department of Neurosurgery, Stanford University, Stanford, CA, USA. seoulman@stanford.edu
authors.forename: Stephen I
authors.initials: SI
authors.lastname: Ryu
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Lim
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Kim
authors.forename: Josemaria
authors.initials: J
authors.lastname: Paterno
authors.forename: Rafer
authors.initials: R
authors.lastname: Willenberg
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Kim
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000592:standards; D001863:Bone Screws / Q000592:standards; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods; D005260:Female; D005360:Fibula / Q000033:anatomy & histology / Q000502:physiology* / Q000637:transplantation; D006801:Humans; D007085:Ilium / Q000033:anatomy & histology / Q000502:physiology* / Q000637:transplantation; D016268:Internal Fixators / Q000592:standards; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D014182:Transplantation, Autologous / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016474:Weight-Bearing / Q000502:physiology