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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