National Guideline Clearinghouse | Techniques for cervical interbody grafting.

Guideline Title
Techniques for cervical interbody grafting.

Bibliographic Source(s)
Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves [trunc]. Techniques for cervical interbody grafting. J Neurosurg Spine 2009 Aug;11(2):203-20. [44 references] PubMed

Guideline Status
This is the current release of the guideline.


full-text:
National Guideline Clearinghouse | Techniques for cervical interbody grafting.







J Neurosurg Spine. 2009 Aug;11(2):203-20.

Techniques for cervical interbody grafting.

Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK; Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons.

Source
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.

Abstract
OBJECT: The objective of this systematic review was to use evidence-based medicine to determine the efficacy of interbody graft techniques.

METHODS: The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical interbody grafting. Abstracts were reviewed and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

RESULTS: Autograft bone harvested from the iliac crest, allograft bone from either cadaveric iliac crest or fibula, or titanium cages and rectangular fusion devices, with or without the use of autologous graft or substitute, have been successful in creating arthrodesis after 1- or 2-level anterior cervical discectomy with fusion (Class II). Alternatives to autograft, allograft, or titanium cages include polyetheretherketone cages and carbon fiber cages (Class III). Polyetheretherketone cages have been used successfully with or without hydroxyapatite for anterior cervical discectomy with fusion. Importantly, recombinant human bone morphogenic protein-2 carries a complication rate of up to 23-27% (especially local edema) compared with 3% for a standard approach.

CONCLUSIONS: Current evidence does not support the routine use of interbody grafting for cervical arthrodesis. Multiple strategies for interbody grafting have been successful with Class II evidence supporting the use of autograft, allograft, and titanium cages.

PMID:19769500[PubMed - indexed for MEDLINE]

Techniques for cervical interbody grafting. [J Neurosurg Spine. 2009] - PubMed result