A novel source of cancellous autograft for ACDF surgery: the manubrium

There are a variety of techniques and biologic options when performing interbody fusion during an anterior cervical discectomy and fusion (ACDF). Autologous graft provides high rates of fusion; however, complications associated with donor site morbidity from the iliac crest have prompted some surgeons to use alternative graft material. Ten patients (8 men, 2 women) with cervical radiculopathy underwent single-level ACDF with plate fixation, titanium mesh cage, and cancellous autograft from the manubrium. Cancellous bone was obtained through a cortical window on the anterior aspect of the manubrium through a 2-cm transverse incision. A minimum 1-year clinical and radiographic follow-up for all patients evaluated fusion rates, donor site morbidity, and patient satisfaction. All patients had immediate postoperative resolution of radicular symptoms and radiographic evidence of solid fusion within 3 months. No patient complained of donor site pain and narcotic pain medication was not required after discharge. No complications associated with the manubrium donor site were noted; however, 1 female patient was dissatisfied with its cosmetic appearance. The manubrium is an effective, safe, and technically facile source of autologous bone graft that yields high fusion rates and patient satisfaction in contemporary ACDF surgery. This new technique to obtain cancellous graft from the manubrium combines the advantages of autologous bone without the morbidity of iliac crest harvest.