Autologous Bone Harvest in Anterior Cervical Spine Surgery: A Quantitative and Qualitative In Vitro Analysis of Cadaveric Tissue.
World Neurosurg. 2018 Apr;112:e134-e139. doi: 10.1016/j.wneu.2017.12.175. Epub 2018 Jan 6.
Rustagi T, Alonso F, Drazin D, Schmidt C, Rostad S, Yilmaz E, Oskouian RJ, Tubbs RS, Chapman JR, Fisahn C.
Abstract
BACKGROUND:
The cervical spine may be used as a harvesting site of local autograft material during anterior cervical discectomy and fusion procedures. We analyzed the quality and composition of bone grafts obtained from different parts of the cervical vertebrae in a cadaveric model.
METHODS:
Five fresh adult human cadavers with intact cervical spines were used. Using a Smith-Robinson anterior approach to expose C4-5 and C5-6 vertebrae, samples from 4 vertebral sites were harvested under a microscope. Anterior osteophytes were removed piecemeal by a Leksell rongeur (sample A). A high-speed burr was used to drill the endplates of C4-5 and C5-6 (sample C) and uncovertebral joints of C4-5 (sample B) and C5-6 (sample D). Then 20 slides (4 per cadaver) were prepared and analyzed.
RESULTS:
Tissue fragmentation was associated with use of the high-speed burr. Sample A had minimal tissue fragmentation. Samples B-D showed moderate to high fragmentation. Cartilage was found in all samples. Of the 20 slides, 6 contained soft tissues (sample A in 4, sample D in 2). Disc material was identified in 6 slides (sample A in 1, sample B in 4, sample D in 1). Sample A had the greatest number of intact osteocytes and chondrocytes, and sample B had the least.
CONCLUSIONS:
Anterior osteophytes provide the highest number of osteocytes, with the highest osteocyte/chondrocyte ratio. Osteocyte viability is a function of vertebral body site and collection technique, with fragmentation caused by use of a high-speed burr decreasing the number of viable osteocytes.
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KEYWORDS:
ACDF; Bone grafting; Bone harvest; Cervical spine