A new source of structural autograft for ACDF surgery: cervical laminae

A prospective study and a technical note.

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.

To describe the clinical and radio graphic outcomes in patients undergoing combined postero-anterior cervical surgery using autologous laminae as bone graft in ACDF.

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.

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.

In patients undergoing combined postero-anterior cervical surgery, structural autograft harvested from the laminae provides an alternative to anterior iliac crest grafting.