Hydroxyapatite/collagen composite graft for anterior cervical discectomy and fusion: a comparison with Iliac crest bone graft

BMC Musculoskelet Disord. 2025 Jun 3;26(1):552. doi: 10.1186/s12891-025-08782-x.

Abstract

Background: The iliac crest bone graft (ICBG) has been traditionally used as the gold standard for anterior cervical discectomy and fusion (ACDF). However, the complication rate associated with harvesting the tricortical ICBG is significantly high. Thus, this study aimed to investigate the efficacy of the hydroxyapatite/collagen (HAp/Col) composite graft combined with an intervertebral cage in ACDF.

Methods: This was a retrospective study investigated 49 consecutive patients who underwent one- or two-level ACDF using the HAp/Col composite graft combined with an intervertebral cage at two institutions from March 2016 to January 2019. Clinical and radiological evaluations were performed before the surgeries and during the postoperative follow-up. Further, the outcomes of ACDF using the HAp/Col composite graft combined with the cage were compared with those of the tricortical ICBG without the cage.

Results: The Japanese Orthopaedic Association (JOA) scores of the HAp/Col and ICBG groups at 2 years postoperatively improved significantly compared with those preoperatively. The two groups did not significantly differ in terms of the recovery rate based on the JOA scores at 2 years postoperatively. The fusion rates in the HAp/Col group (one-level, 95.7%; two-level, 92.0%) were comparable to those in ICBG group (one-level, 100%; two-level, 88.9%) at 2 years postoperatively. The surgical time was significantly shorter in the HAp/Col group (one-level, 113.2 min; two-level, 157.5 min) than in the ICBG group (one-level, 161.0 min; 2-level, 223.3 min) for both one- and two-level fusions. Intraoperative blood loss was significantly lower in the HAp/Col group than in the ICBG group in two-level fusion (HAp/Col, 34.1 g; ICBG, 215.4 g).

Conclusions: The HAp/Col composite graft with an intervertebral cage could be a safe and effective alternative scaffold to the conventional autologous iliac tricortical grafts in ACDF.

Clinical trial number: Not applicable.

Keywords: Anterior cervical discectomy and fusion (ACDF); Cervical anterior surgery; Cervical spine; Fusion rate; Hydroxyapatite/ collagen; Iliac bone graft; Surgical result.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Bone Transplantation* / methods
  • Cervical Vertebrae* / diagnostic imaging
  • Cervical Vertebrae* / surgery
  • Collagen*
  • Diskectomy* / adverse effects
  • Diskectomy* / instrumentation
  • Diskectomy* / methods
  • Durapatite*
  • Female
  • Follow-Up Studies
  • Humans
  • Ilium* / transplantation
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Fusion* / adverse effects
  • Spinal Fusion* / instrumentation
  • Spinal Fusion* / methods
  • Treatment Outcome

Substances

  • Durapatite
  • Collagen