Postoperative spondylitis after posterior lumbar interbody fusion using cages

The recommended surgical options for postoperative wound infections after instrumented spine surgery include a wide debridement and irrigation with antibiotics. In most cases, implant removal is not recommended for a solid fusion. However, there are few reports on the treatment choices for persistent postoperative wound infections following a posterior lumbar interbody fusion (PLIF) using cages. This paper reviewed ten patients referred to our department, who underwent revision surgery for a postoperative, deep infection after a PLIF with cages. The surgery included an anterior radical debridement and interbody fusion with removal of all implants. The clinical and laboratory results, including a bacteriologic study for the causative organism and the radiological changes, were analyzed. All patients complained of persistent severe back pain after the primary surgery. MRSA was the main organism found in these patients (five cases). Complete bony fusion was obtained in nine patients (90%). In one patient, back pain and radiating pain prevented him from returning to his original work. Despite the anterior interbody fusion with an autogenous iliac bone graft, all cases had a complete collapse of the intervertebral disc space, without a dislodgement or collapse of the graft bone. The mean loss of the height and lordosis in the involved segment was 12.7 mm (range 4–46 mm) and 5.6° (range 0–15°), respectively. Anterior radical debridement with the removal of all implants would be an effective way to manage patients with postoperative spondylitis after a PLIF using cages.     

Fate of the transpedicular intervertebral bone graft after posterior stabilisation of thoracolumbar fractures

The authors present a retrospective clinical and radiological study addressing the outcome after posterior stabilisation of thoracolumbar fractures with intervertebral fusion via transpedicular bone grafting. The study included computed tomographic (CT) scan after implant removal for analysis of the intervertebral fusion and incorporation of the intervertebral bone graft and its influence on postoperative re-kyphosing. Twenty-nine patients with acute fractures of the thoracolumbar spine, treated between 1988 and 1995 at the Department of Trauma Surgery, Hannover Medical School, underwent posterior stabilisation and interbody fusion with transpedicular cancellous bone grafting. This study group was followed clinically and radiologically for a mean of 3.5 years. All patients underwent spiral CT scan with sagittal reconstruction after implant removal. Twenty-four type A, four type B, and one type C lesion were posteriorly stabilised and transpedicular intervertebral bone grafting was performed. The operative time averaged 2 h 50 min, the intraoperative fluoroscopy time 4 min 7 s, and the mean intraoperative blood loss was 376 ml. Four patients out of six with an incomplete neurologic lesion (Frankel/ASIA D) improved to Frankel/ASIA grade E. Two complications were observed: one delayed wound healing and one venous thrombosis with secondary pulmonary embolism. Compared to the preoperative status, our follow-up examinations demonstrated permanent social sequelae: the percentage of individuals able to do physical labor was reduced, whereas the proportion of unemployed or retired patients increased. The assessment of complaints and functional outcome with the Hannover Spine Score reflected a significant difference ( P<0.001) between the status before injury (96.6/100 points) and at follow-up (64.4/100 points). The radiographic follow-up revealed a mean loss of correction of 7.8 degrees ( P<0.005). CT scans after implant removal showed an interbody fusion and incorporation of the transpedicular bone graft in ten patients (34%). In another ten patients (34%), the CT scans demonstrated the interbody fusion at the anterior and posterior walls of the vertebral body via direct contact due to collapse of the disc space. In these patients, the bone graft was not incorporated and no central interbody fusion could be found. In nine patients (31%) neither interbody fusion nor incorporation of the transpedicular graft was achieved. A frequent and reliable intervertebral fusion could not be achieved with the described technique of transpedicular bone grafting. The ineffectiveness of the intervertebral graft was found to be a reason for postoperative re-kyphosing.     

Are 2 cages needed with instrumented PLIF? A comparison of 1 versus 2 interbody cages in a military population

Bovine biomechanical data have demonstrated adequate stability of a single threaded interbody cage when combined with a unilateral facet screw during posterior lumbar disc excision and interbody fusion (PLIF). Instrumented PLIF surgery using 1 versus 2 interbody cages was studied in 35 military men with disc disease and chronic low back pain. All patients underwent instrumented PLIF with bilateral diskectomy and partial facetectomy, pedicle screws, autogenous iliac crest bone graft, 1 or 2 interbody cages, and posterior lateral fusion. After an average of 15 months' follow-up, the 2-cage group had a higher rate of dural tear, but rates of other complications, hospital stay, fusion rates, pain levels, functional outcomes, and patient satisfaction were good and did not differ between groups. Costs were higher for the 2-cage group by 1728 dollars per patient.     

Lumbar disc herniation associated with separation of the posterior ring apophysis: analysis of five surgical cases and review of the literature

BACKGROUND: Separation of the posterior ring apophysis of an adjacent vertebral body can sometimes accompany lumbar intervertebral disc herniation. The condition can be both difficult to detect in conventional radiographs and is somewhat controversial to treat. Although there is general agreement on the frequent need for surgery, there is no consensus on the choice of operation. One procedure, posterior lumbar interbody fusion (PLIF), has never been examined for effectiveness. METHOD: Computed tomography (CT) either or with discography (CTD) was compared to plane radiographs and magnetic resonance imaging (MRI) for its ability to reveal the fragmentation. Five cases were identified and the severity of the condition evaluated using the Japanese Orthopaedic Association's Assessment of Treatment for Low Back Pain (JOA score). The fragments were removed by impaction with a shoe shaped device and posterior lumbar interbody fusion (PLIF) was performed using autogenous iliac crest bone. A second evaluation using the JOA score was performed after a 4 to 5 year follow-up. FINDINGS: CT identified the separation in all 5 cases while plain films showed the defect in two and MRI in none. JOA scores prior to surgery were between 5 and 19 (mean, 13) and between 25 and 29 (mean, 27.4) at follow-up. The scores represented a recovery of 80% to 100%t (mean, 89.4). INTERPRETATION: CT and CT discography (CTD) are the diagnostic tools of choice for detecting this condition. Posterior lumbar interbody fusion (PLIF) is an effective procedure for patients who have low back pain due to lumbar disc herniation accompanied by a separation of the posterior ring apophysis.     

同种皮质骨融合支架的研制及临床应用

目的研究同种皮质骨融合支架行后路椎间融合术治疗腰椎滑脱的临床疗效。方法对12例腰椎滑脱患者,用同种皮质骨融合支架行后路椎体间融合加内固定术。根据手术前后的椎间隙高度的变化和JOA评分,观察临床疗效。结果12例均获得随访,时间3-6个月,术后椎间隙高度明显恢复,无神经系统并发症,无融合支架脱出,切口无感染,JOA评分术后改善率为93.5%。结论该手术保留的骨性终板有利于防止植入物陷入椎体,能有效地维持椎间隙高度。术中无须取自体骨,且植骨面积最大化,有利于融合,植骨内固定一次完成。同种皮质骨融合支架置入牢固,具有骨传导和骨诱导作用,手术操作简单,是一种良好的椎间融合材料。     

Extension CT scan: its suitability for assessing fusion after posterior lumbar interbody fusion

Posterior lumbar interbody fusion (PLIF) is a popular procedure for treating lumbar canal stenosis with spinal instability, and several reports concerning fusion assessment methods exist. However, there are currently no definitive criteria for diagnosing a successful interbody fusion in the lumbar spine. We suggested evaluating fusion status using computed tomography (CT) in extension position to detect pseudoarthrosis more precisely. The purpose of this study was to evaluate its usefulness for determining bone union quality after PLIF. Eighty-one patients who underwent PLIF at 97 levels were retrospectively enrolled. The study population included 48 men and 33 women (mean age 58.9 years, range 21–85 years). Patients were followed up for more than 12 months after surgery. The mean follow-up period was 27.6 months (range 14–49 months). Fusion status was evaluated using three ways: flexion–extension radiographs, CT images in flexion and extension position. In the flexion–extension radiographs, mobility of more than 3°, a remaining clear zone, or an uncertain bone connection constituted an incomplete union. For CT images, a remaining clear zone, a gas pattern, or an uncertain bone connection constituted an incomplete union. Flexion–extension radiographs demonstrated a solid fusion in 90.7% of the 97 levels at 10.7 months postoperatively. When fusion was demonstrated on flexion–extension radiographs, the rate of fusion affirmed by flexion CT and extension CT was 87.6 and 69.1% of the levels assessed, respectively. The rate of pseudoarthrosis detected on extension CT images was significantly higher than that on flexion–extension radiographs (P < 0.001) and flexion CT (P < 0.01). The rate of fusion achieved on extension CT was 85.6% at 15.1 months postoperatively. Extension CT could detect pseudoarthrosis more clearly than flexion–extension radiography and flexion CT. The CT images are influenced by body position and dilating anterior disc space in extension CT contributes to detect pseudoarthrodesis. Thus, extension CT was a useful method for assessing fusion status after PLIF.     

Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study

Purpose

The purpose of this study is to compare bone union rate between autologous iliac bone and local bone graft in patients treated by posterior lumbar interbody fusion (PLIF) using carbon cage for single level interbody fusion.

Methods

The subjects were 106 patients whose course could be observed for at least 2 years. The diagnosis was lumbar spinal canal stenosis in 46 patients, herniated lumbar disk in 12 patients and degenerative spondylolisthesis in 51 patients. Single interbody PLIF was done using iliac bone graft in 53 patients and local bone graft in 56 patients. Existence of pseudo-arthrosis on X-P (AP and lateral view) was investigated during the same follow up period.

Results

No significant differences were found in operation time and blood loss. Significant differences were also not observed in fusion grade at any follow up period or in fusion progression between the two groups. Donor site pain continued for more than 3 months in five cases (9 %). The final fusion rate was 96.3 versus 98.3 %.

Conclusions

Almost the same results in fusion were obtained from both the local bone group and the autologous iliac bone group. Fusion progression was almost the same. Complications at donor sites were seen in 19 % of the cases. From the above results, it was concluded that local bone graft is as beneficial as autologous iliac bone graft for PLIF at a single level.     

The maturation of grafted bone after posterior lumbar interbody fusion with an interbody carbon cage: a prospective five-year study

We evaluated the maturation of grafted bone in cases of successful fusion after a one- or two-level posterior lumbar interbody fusion (PLIF) using interbody carbon cages. We carried out a five-year prospective longitudinal radiological evaluation of patients using plain radiographs and CT scans. One year after surgery, 117 patients with an early successful fusion were selected for inclusion in the study. Radiological evaluation of interbody bone fusion was graded on a 4-point scale. The mean grades of all radiological and CT assessments increased in the five years after surgery, and differences compared to the previous time interval were statistically significant for three or four years after surgery. Because the grafted bone continues to mature for three years after surgery, the success of a fusion should not be assessed until at least three years have elapsed. There were no significant differences in the longitudinal patterns of grafted bone maturity between iliac bone and local bone. However, iliac bone grafting may remodel faster than local bone.     

后路椎体间打压植骨治疗老年人腰椎退变性疾病的临床报道

目的 探讨椎体间微粒骨打压植骨治疗老年人腰椎退变性疾病的手术技术和初期临床疗效报道。方法 本组为2002年5月～2004年8月在对28位60岁以上老年人腰椎退变性疾病患者手术治疗的同时进行椎体间微粒骨打压植骨融合。观察手术前后的症状、体征、影像学上的腰椎前凸角、椎间隙高度指数的变化,以及手术后CT检查椎体间植骨面积,同时随访6～26个月观察初期临床疗效和融合率。结果 几乎所有患者手术后原症状和体征均得到缓解,影像学上的腰椎前凸角、椎间隙高度指数都有明显恢复,手术后6～26个月,脊柱融合率达到96．4％。没有发生植入骨的吸收、移位和沉陷。并发症主要为术中硬脊膜撕裂、神经根牵拉以及出血多等。结论 后路减压、固定、椎体间微粒骨打压植骨融合治疗老年人腰椎退变性疾病早期临床疗效满意。     

A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study

Objective

A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery.

Methods

A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared.

Results

The mean follow-up time was 19 months in no cage group and 18.5 months in cage group (P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively (P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group (P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group (P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up.

Conclusion

Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF.     

The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

Objective

To evaluate whether a synthetic bone chip made of porous hydroxyapatite can effectively extend local decompressed bone graft in instrumented posterior lumbar interbody fusion (PLIF).

Methods

130 patients, 165 segments, who had undergone PLIF with cages and instrumentation for single or double level due to degenerative conditions, were investigated retrospectively by independent blinded observer. According to the material of graft, patients were divided into three groups. HA group (19 patients, 25 segments): with hydroxyapatite bone chip in addition to autologous local decompressed bone, IBG group (25 patients, 28 segments): with autologous iliac crest bone graft in addition to local decompressed bone and LB group (86 patients, 112 segments): with local decompressed bone only. Radiologic and clinical outcome were compared among groups and postoperative complications, transfusion, time and cost of operation and duration of hospitalization were also investigated.

Results

Radiologic fusion rate and clinical outcome were not different. Economic cost, transfusion and hospital stay were also similar. But operation time was significantly longer in IBG group than in other groups. There were no lasting complications associated with HA and LB group with contrast to five cases with persisting donor site pain in IBG group.

Conclusion

Porous hydroxyapatite bone chip is a useful bone graft extender in PLIF when used in conjunction with local decompressed bone.     

Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation

The availability of lumbar interbody cages has fuelled renewed interest in interbody fusion. Despite this, there is no consensus regarding the best non-invasive method for evaluation of interbody fusion, especially where cages have been used. The purpose of this study was to determine whether high-quality thin-slice (1- to 3-mm) computed tomography (CT) scans allow proper evaluation of interbody fusion through titanium cages. Patients undergoing lumbar interbody fusion were prospectively evaluated with CT scan and plain radiographs 6 months following surgery. These images were blindly and independently evaluated by a consultant radiologist and a spine research fellow, for bridging bony trabeculation both through and surrounding the cages as well as for changes at the cage endplate interface. Fifty-three patients (156 cages) undergoing posterior lumbar interbody fusion using titanium interbody cages were evaluated. Posterior elements were used to pack the cages and no graft was packed outside the cages. The outcome data were analysed using the Kappa co-efficient and chi-squared analysis. On CT scan, both observers noted bridging trabeculation in 95% of the cages (Kappa 0.85), while on radiographs this was present in only 4% (Kappa 0.74). Both observers also identified bridging trabeculation surrounding the cages on CT scan in 90% of cages (Kappa 0.82), while on the radiographs this was 8% (Kappa 0.86). Radiographs also failed to demonstrate all the loose cages. The results of the study show that high-quality CT scans show images suggesting bridging bony trabeculae following the use of titanium interbody cages. They also appear to show consistent bone outside the cages in spite of no bone graft having been used, and they appear to be better than plain radiographs in the early detection of cage loosening.     

Changes in the loads on an internal spinal fixator after iliac-crest autograft

Spines are often stabilised posteriorly by internal fixation and anteriorly by a bone graft. The effect of an autologous bone graft from the iliac crest on implant loads is unknown. We used an internal spinal fixation device with telemetry to measure implant loads for several body positions and activities in nine patients before and after anterior interbody fusion. With the body upright, implant loads were often higher after than before fusion using a bone graft. Distraction of the bridged region led to high implant loads in patients with a fractured vertebra and to marked changes in load in those with degenerative instability. Leaving the lower of the bridged intervertebral discs intact led to only small changes in fixator load after anterior interbody fusion. A bone graft alone does not guarantee a reduction of implant loads.     

Advances in posterior lumbar interbody fusion

Since the introduction of the PLIF by Cloward in the 1950s, there have been great improvements in our understanding of the pathophysiology of spinal degenerative diseases and the potential morbidities associated with their surgical management. The advent of durable interbody fusion cages and bone grafting alternatives has lessened the morbidity of bone graft harvesting and disc space collapse and has providing improved stiffness and stability to the affected spinal motion segment. Although criticized by some surgeons for the potential for spinal destabilization and nerve root injuries, newer techniques of posterior interbody access and improved implant designs have led to shortened surgical times, less neurologic injury, and improved overall outcomes. The introduction of the transforaminal lumbar interbody fusion procedure has allowed surgeons to achieve successful fusion without the risk of nerve root tethering that is seen so frequently with standard PLIF techniques. Further study and long-term follow-up regarding its efficacy are necessary before it can be recommended to supplant the more traditional PLIF techniques.     

后路椎体间微粒骨打压植骨融合

目的探讨后路椎体间微粒骨打压植骨的手术技术和临床可行性。方法对28例60岁以上腰椎退变性疾病患者、2例L1骨折脱位患者和1例T12硬脊膜瘤患者行后路椎体间微粒骨打压植骨融合。观察手术前后症状、体征、X线片腰椎前凸角、椎间隙高度指数的变化,以及手术后CT检查椎体间植骨面积。结果随访6~26个月。术前症状及体征均缓解,腰椎前凸角、椎间隙高度指数均有明显恢复,脊柱融合率达96.1%。未发生植入骨的吸收、移位和沉陷。主要有手术中硬脊膜撕裂、神经根牵拉以及手术出血等并发症。结论后路椎体间微粒骨打压植骨融合是一种可行的椎体间融合方法。     

Segmental stability and compressive strength of posterior lumbar interbody fusion implants

STUDY DESIGN: Human cadaveric study on initial segmental stability and compressive strength of posterior lumbar interbody fusion implants. OBJECTIVES: To compare the initial segmental stability and compressive strength of a posterior lumbar interbody fusion construct using a new cortical bone spacer machined from allograft to that of titanium threaded and nonthreaded posterior lumbar interbody fusion cages, tested as stand-alone and with supplemental pedicle screw fixation. SUMMARY OF BACKGROUND DATA: Cages were introduced to overcome the limitations of conventional allografts. Radiodense cage materials impede radiographic assessment of the fusion, however, and may cause stress shielding of the graft. METHODS: Multisegmental specimens were tested intact, with posterior lumbar interbody fusion implants inserted into the L4/L5 interbody space and with supplemental pedicle screw fixation. Three posterior lumbar interbody fusion implant constructs (Ray Threaded Fusion Cage, Contact Fusion Cage, and PLIF Allograft Spacer) were tested nondestructively in axial rotation, flexion-extension, and lateral bending. The implant-specimen constructs then were isolated and compressed to failure. Changes in the neutral zone, range of motion, yield strength, and ultimate compressive strength were analyzed. RESULTS: None of the stand-alone implant constructs reduced the neutral zone. Supplemental pedicle screw fixation decreased the neutral zone in flexion-extension and lateral bending. Stand-alone implant constructs decreased the range of motion in flexion and lateral bending. Differences in the range of motion between stand-alone cage constructs were found in flexion and extension (marginally significant). Supplemental posterior fixation further decreased the range of motion in all loading directions with no differences between implant constructs. The Contact Fusion Cage and PLIF Allograft Spacer constructs had a higher ultimate compressive strength than the Ray Threaded Fusion Cage. CONCLUSIONS: The biomechanical data did not suggest any implant construct to behave superiorly either as a stand-alone or with supplemental posterior fixation. The PLIF Allograph Spacer is biomechanically equivalent to titanium cages but is devoid of the deficiencies associated with other cage technologies. Therefore, the PLIF Allograft Spacer is a valid alternative to conventional cages.     

Posterior lumbar interbody fusion (PLIF) with cages and local bone graft in the treatment of spinal stenosis

Posterior lumbar interbody fusion (PLIF) implants are increasingly being used for 360 degrees fusion after decompression of lumbar spinal stenosis combined with degenerative instability. Both titanium and PEEK (PolyEtherEtherKetone) implants are commonly used. Assessing the clinical and radiological results as well as typical complications, such as migration of the cages, is important. In addition, questions such as which radiological parameters can be used to assess successful fusion, and whether the exclusive use of local bone graft is sufficient, are frequently debated. We prospectively evaluated 30 patients after PLIF instrumentation for degenerative lumbar spinal canal stenosis, over a course of 42 months. In all cases, titanium cages and local bone graft were used for spondylodesis. The follow-up protocol of these 30 cases included standardised clinical and radiological evaluation at 3, 6, 12 and 42 months after surgery. Overall satisfactory results were achieved. With one exception, a stable result was achieved with restoration of the intervertebral space in the anterior column. After 42 months of follow-up in most cases, a radiologically visible loss of disc space height can be demonstrated. Clinically relevant migration of the cage in the dorsal direction was detected in one case. Based on our experience, posterior lumbar interbody fusion (PLIF) can be recommended for the treatment of monosegmental and bisegmental spinal stenosis, with or without segmental instability. Postoperative evaluation is mainly based on clinical parameters since the titanium implant affects the diagnostic value of imaging studies and is responsible for artefacts. The results observed in our group of patients suggest that local autologous bone graft procured from the posterior elements after decompression is an adequate material for bone grafting in this procedure.     

Experience in posterior lumbar interbody fusion: unicortical versus bicortical autologous grafts

Over the past seven years, 96 PLIF operations were performed with the autologous bone graft method. In 44 cases, unicortical bone grafts were obtained from the posterior iliac crest area. In the remaining 52 cases, bicortical bone grafts were obtained from the anterior iliac crest. The failure rate in the patients treated by interbody fusion with the unicortical posterior iliac crest graft was 11.8%. The failure rate in patients treated by interbody fusion with bicortical bone grafts was only 1.9%. The patients were ambulatory three to four days after the operation. In cases of spondylolysis and spondylolisthesis, interbody fusion should be coupled with some manner of posterior internal fixation. The extraction of two pieces of bicortical bone from the anterior iliac crest, measuring 1.2 cm or 1.3 cm by 2.5 cm, may cause weakness of the pelvic bone. Therefore, the bicortical grafting in PLIF should be limited to severely disabled patients with complete spinal canal stenosis or very large myelographic defects.     

前路和后路腰椎椎体间融合内固定术治疗下腰椎不稳的对比研究

目的 对比评价前路和后路腰椎椎体间融合内固定术治疗下腰椎不稳的效果.方法 将45例下腰椎不稳分为两组,前路手术组11例,后路手术组34例,分别行前路或后路腰椎体间融合内固定术,随访分析疗效、融合情况和并发症,测量和比较手术前后病人ODI、VAS和椎体间高度、角度.结果 患者获平均15个月随访,无严重并发症发生.前路组平均手术时间90 min,平均失血量180 ml,疗效优良率为90.9%,椎问融合率100%.后路组平均手术时间170 min,平均失血量470 ml,疗效优良率为85.3%,椎间融合率100%.两组术后1年ODI和VAS均较术前明显减少(P<0.01),椎间高度、角度均明显增加(P<0.05).两组间的术前及术后1年ODI、VAS、椎间高度、角度等指标无明显差异(P>0.05);前路组较后路组手术时间和出血量明显减少(P<0.05).结论 前路和后路腰椎体间融合内固定术治疗下腰椎不稳均可达到满意的椎间融合率和临床效果,前路腰椎体间融合内固定术手术时间和出血量较少.     

Box Cages Packed With Local Decompression Bone Were Efficient in Anterior Cervical Discectomy and Fusion: Five- to 10-Year Follow-up

STUDY DESIGN.: A retrospective study. OBJECTIVE.: To assess the radiographical bony union and clinical outcomes of 207 patients who underwent an anterior cervical discectomy and fusion (ACDF) with only local decompression bone for the treatment of cervical disc degeneration. SUMMARY OF BACKGROUND DATA.: Many sources of bone graft have been used for ACDF. Autologous iliac bone is most likely suitable for biologic bone fusion ability, but there may be many problems such as high donor site morbidity. Allograft and artificial bones are less effective for bone fusion. Use of local decompression bone could be a good solution. METHODS.: A total of 207 patients (range, 35-80 yr) underwent ACDF, using carbon fiber-reinforced polyetheretherketone cage lled with local decompression bone with anterior cervical plating to treat symptomatic cervical disorders. Computed tomographic scan of the cervical spine was used to assess fusion rates, and Odom's criteria were used to evaluate the clinical outcome. RESULTS.: Almost all patients had symptomatic improvement, and 97% of patients (201 of 207) exhibited excellent/good clinical outcomes. All interbody disc spacers with local decompression bone achieved successful fusion, confirmed by radiographs and computed tomographic scans, and no cage subsidence occurred at all levels. CONCLUSION.: As applied in anterior cervical fusion, the local decompression bone embedded into carbon fiber-reinforced polyetheretherketone cages is enough and can achieve successful fusion, poignant clinical outcomes while achieving no donor site morbidity.