The decision-making process: allograft versus autograft.

Area of Science:

• Orthopedic Surgery
• Spinal Fusion Techniques
• Biomaterials in Medicine

Background:

• The choice between allograft and autograft for ventral cervical fusions is a significant clinical consideration.
• Autograft is associated with higher arthrodesis rates and less graft collapse but carries harvest-related morbidity.
• Allografts avoid harvest morbidity but historically show lower arthrodesis and increased graft collapse.

Purpose of the Study:

• To evaluate the comparative efficacy and safety of allograft versus autograft in ventral cervical fusions.
• To analyze factors influencing fusion outcomes, such as multilevel surgery and smoking status.
• To assess the impact of ventral cervical plates on allograft utilization and outcomes.

Main Methods:

• Review of prospective randomized trials comparing allograft and autograft in cervical spine surgery.
• Analysis of clinical evidence regarding arthrodesis rates, graft collapse, and surgical morbidity.
• Assessment of outcomes in relation to surgical complexity (multilevel procedures) and patient factors (smoking).

Main Results:

• Autograft demonstrates superior arthrodesis rates and reduced graft collapse compared to allograft.
• Allograft use is linked to decreased fusion success and increased graft collapse, particularly in multilevel procedures and smokers.
• Ventral cervical plates have improved allograft fusion rates and reduced collapse, making it a more viable option.

Conclusions:

• While autograft remains effective, its associated morbidity is a drawback.
• Allograft offers a safer alternative regarding harvest complications, with improved outcomes when used with ventral cervical plates.
• The decision should weigh the trade-offs between autograft morbidity and allograft fusion rates, considering surgical context and patient factors.