Is tutobone an efficient alternative to other implants used in anterior cervical discectomy and fusion surgeries?

Background: The graft site morbidity following iliac crest harvesting is significant. To overcome this, different bone substitutes like coral dowels, solvent dissolved bovine/human bone substitutes, and carbon fiber/titanium cages have been used. This study was undertaken to assess the postoperative radiological fusion rates and symptom relief in patients who had Tutobone used as an interbody spacer compared to autologous bone graft (ABG), cages, surgibone and coral dowels. Methods: This was a retrospective, observational study. Case notes and post-operative cervical spine radiographs done at two subsequent follow-ups were reviewed. Data were derived from all Anterior Cervical Discectomy and fusion (ACDF) surgeries performed at our centre over a 10-year period for degenerative cervical spine disease. We analysed 530 patients. Exclusion criteria included incomplete notes, complex cervical surgery (both anterior and posterior fixation and vertebrectomies). Patients were divided into 3 groups, patients treated with (1) Autologous bone graft, (2) Tutobone and (3) other implants which include cages, surgibone and coral dowels. Results: An analysis of 530 patients who had ACDF with either ABG (n = 328) or tutobone (n = 95) or other implants (n = 90) is presented. A significantly greater number of patients in whom autologous bone was used had more than one level surgery. The median follow-up times were 3 months and 12 months. Rates of fusion and time to fusion with bone substitutes were inferior to ABG in our series, but there was not much to choose amongst them. Conclusion: The use of ABG in ACDF leads to fusion in a shorter duration and greater proportion of patients, when compared to substitutes. Other implants like Tutobone (cheaper alternative), cages, etc can also be used in ACDF procedures with good efficacy with the added advantage of preventing donor site morbidity. There was no association between fusion rates and symptom relief and between use of plating and fusion.