Anterior cervical arthrodesis using an osteoconductive scaffold: The use of beta-tricalcium phosphate with local bone marrow aspirate in over 100 patients

One-hundred and twenty-three consecutive low-risk paients undergoing anterior cervical diskectomy and fusion at , 2, or 3 levels, for either myelopathy or radiculopathy, ere treated by a single surgeon using a polyetheretherktone (PEEK) spacer containing an osteoconductive putty onsisting of a compression-resistant, 90% porous beta trialcium phosphate ( -TCP), and collagen (Vitoss Pack; rthovita, Malvern, Pennsylvania) reconstitued with bone arrow aspirate from the adjacent vertebral bodies and an nterior cervical plate (Reflex; Stryker Spine, Kalamazoo, ichigan). Patients were prospectively followed to evaluate usion outcomes and complications in a study approved by he Institutional Review Board of Washington University chool of Medicine. The senior author’s practice is to stratify patients accordng to risk for failed fusion. Patients with tobacco use, prior ailed fusion, certain medications (such as chronic steroids), r with certain collagen disorders are stratified as high-risk. ll patients enrolled in this study were considered low-risk or fusion failure. The surgical treatment method and results n high-risk patients is being prepared separately. After a standard anterior cervical diskectomy was perormed for decompression, 2.5 mL of bone marrow was spirated from the adjacent vertebral body from the Caspar ost tract using a 10-mL syringe and a blunt tip needle. This one marrow aspirate was injected in a 1:1 ratio onto 2.5 L of a 90% porous -TCP/10% collagen mix. This putty as packed into the PEEK spacer, which was then inserted nto the diskectomy defect and countersunk. Additional utty was packed on one side of the PEEK spacer, and entral to the spacer, prior to insertion of the anterior cerical plate. Patients were evaluated at 6 weeks and 3 months with nteroposterior and lateral radiographs, and at 6 months ith anteroposterior, lateral, flexion, and extension radioraphs. Fusion, defined as bridging bone and less than 2° of otion on dynamic films, was assessed by an independent, linded radiologist.