Techniques for cervical interbody grafting.
OBJECTIVE
The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.


METHODS
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.


RESULTS
Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23-27% (especially local edema) compared with 3% for a standard approach.


CONCLUSIONS
Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.
Ryken
Timothy C
TC
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Heary
Robert F
RF
Matz
Paul G
PG
Anderson
Paul A
PA
Groff
Michael W
MW
Holly
Langston T
LT
Kaiser
Michael G
MG
Mummaneni
Praveen V
PV
Choudhri
Tanvir F
TF
Vresilovic
Edward J
EJ
Resnick
Daniel K
DK
D016025:Bone Transplantation / Q000379:methods*; D002574:Cervical Vertebrae / Q000601:surgery*; D006801:Humans; D013123:Spinal Fusion / Q000379:methods*