title: A new source of structural autograft for ACDF surgery: cervical laminae.
abstract: METHODS
  A prospective study and a technical note.
  
  
  BACKGROUND
  Autograft is considered to be the gold standard in achieving optimal fusion in anterior cervical discectomy and fusion (ACDF). In patients with combined postero-anterior cervical procedure, whether the cervical laminae harvested from laminectomy can be used as astructural bone graft in ACDF? Few studies have reported about this.
  
  
  OBJECTIVE
  To describe the clinical and radio graphic outcomes in patients undergoing combined postero-anterior cervical surgery using autologous laminae as bone graft in ACDF.
  
  
  METHODS
  Twenty-two patients (13 males, 9 females) with cervical spondylotic myelopathy underwent one-level combined postero-anterior procedure with anterior plate fixation from January 2010 to January 2014. All the patients received computed tomography scan before surgery and the heights of the target laminae and the middle intervertebral space were measured. Then, patients underwent combined postero-anterior surgery with laminectomy and ACDF. The structural laminae obtained from laminectomy were used as bone graft in ACDF. The clinical and radiographic outcomes of the patients were analyzed and the effectiveness and safety of the surgery was evaluated.
  
  
  RESULTS
  The average heights of the target laminae and the middle intervertebral space were 11.18±1.05 mm and 5.75±0.58 mm, respectively. Statistical significant difference was found between the heights of the laminae and the space (P<0.001). The mean operative time was 192±37 minutes with an average blood loss volume of 235±71 ml. All patients were followed up and the average follow-up period was 17.5±3.1 months. All patients had immediate postoperative resolution of symptoms and radiographic evidence of solid fusion 3 months later. Postoperatively, excellent results were reported in 62.5%, good results in 18.8%, and fair results in 18.8% of the patients according to Odom's criteria. Visual analog scale score of the neck and extremities pain was significantly decreased after the surgery (P=0.014). The average preoperative and postoperative lordosis angles of the cervical spine were24.42°±13.84° and 32.91°±7.79°, and the difference was significant (P<0.01). Little loss of the angle was noted at final follow-up (32.91°±7.79° VS 29.30±7.88, P=0.51). Anterior intervertebral space height was significantly increased (P<0.001) after the surgery and a little declined at final follow-up (P=0.43). No intraoperative complication was noted in the patients and three patients got self-limiting dysphagia postoperatively, who recovered spontaneously.
  
  
  CONCLUSIONS
  In patients undergoing combined postero-anterior cervical surgery, structural autograft harvested from the laminae provides an alternative to anterior iliac crest grafting.
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Jiaming
authors: J
authors: Liu
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Xu
authors: X
authors: Xiong
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Xinhua
authors: X
authors: Long
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Yong
authors: Y
authors: Shu
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Shanhu
authors: S
authors: Huang
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Dong
authors: D
authors: Yang
authors: Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University Nanchang 330006, P.R. China.
authors: Zhili
authors: Z
authors: Liu
keywords: Autograft; anterior cervical discectomy and fusion; laminae; spinal fusion