Anterior cervical discectomy and fusion (ACDF) autograft versus graft substitutes: what do patients prefer?-A clinical study.
BACKGROUND
Patient dissatisfaction with donor site morbidity has led to the search for alternative grafting options and techniques. This report compares patient satisfaction rates between autograft and graft substitutes for anterior cervical discectomy and fusion (ACDF).


METHODS
This study was performed with the approval of the local area health network ethics committee. Over a 9-year period, the author performed 574 ACDF procedures (697 levels). Of these, 22 patients had previous surgery with autograft, with a subsequent ACDF procedure performed using a graft substitute. Patients rated their satisfaction with pain, recovery, and preference of autograft versus a bone graft substitute. Graft substitutes used include: tricalcium phosphate/hydroxyapatite (TCP/HA) composite and iFactor placed within a polyetheretherketone (PEEK) cage.


RESULTS
Results demonstrated that 21/22 patients achieved a solid fusion with the graft substitute. A total of 20/22 patients rated the autograft incision more painful than the anterior cervical incision, and 21/22 preferred the graft substitute. Three patients had adjacent segment disc replacement performed after autograft/ACDF. All patients reported preference for the total disc replacement (TDR) procedure in terms of recovery and postoperative pain.


CONCLUSIONS
Patient satisfaction with bone graft substitutes is very high compared with autograft with all but one (21/22) preferring the graft substitute option. The author questions the traditional recommendation that autograft is the "gold standard" for ACDF. In modern age of graft substitutes, autograft should not be considered the gold standard, but an index option between other options for comparison.
NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales, Sydney, Australia;; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
Monish M
MM
Maharaj
NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales, Sydney, Australia;; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
Kevin
K
Phan
NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia;; Faculty of Medicine, University of New South Wales, Sydney, Australia;; NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
Ralph J
RJ
Mobbs
Anterior cervical fusion; biphasic calcium phosphate; plating; polyetheretherketone (PEEK); synthetic bone graft
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