Structural Interbody Grafting

Options of structural grafting anteriorly include cages, structural autograft and structural allograft. Structural autograft probably the fastest method of fusion, but is associated with fairly high morbidity. It is reported that the incorporation of the autograft was slightly better than the allograft. However, the morbidity and pain suffered by the patients was greater in the autograft group. It was reported that 66 out of 67 fresh frozen allografts showed remodeling and incorporation at a minimum of 5 years postoperatively without any incidence of graft collapse. These cases were all supplemented with posterior instrumentation and autogenous grafting. Also, the results with cages are very successful. There is an extremely low incidence of cage extrusion, substantial cage subsidence, and cage collapse. However, determining the fusion inside and around the cages is very difficult both by plain radiographs and by CT.

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