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Author Notes:

Corresponding Author: Jeffrey A. Konopka, Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA 30307, USA. Email: jkonopk@emory.edu

The author(s) received no financial support for the research, authorship, and/or publication of this article.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.



  • ACDF
  • AO Spine members
  • graft
  • survey

ACDF Graft Selection by Surgeons: Survey of AOSpine Members


Journal Title:

Global Spine Journal


Volume 7, Number 5


, Pages 410-416

Type of Work:

Article | Final Publisher PDF


Study Design: Cross-sectional survey study. Objective: To determine what are the most commonly used graft materials in anterior cervical discectomy and fusion and whether the choice of graft is affected by surgeon’s training, years in practice, geographic location, practice setting, or surgeon’s perceived difficulty in achieving fusion. Methods: A 23-question survey was sent out to 5334 surgeons using the Global AO Spine database. Response data was then stratified into surgeon training, years of practice, practice type, and global region. Results: Overall, surgeons believe that graft selection affects fusion rates (89.3% of surgeons) and affects time to fusion (86.0% of surgeons). The use of a cage is currently the most common structural graft component used worldwide at 64.1%. Of surgeons that use cages, the PEEK Cage makes up 84%. North American surgeons differ from this global trend and use composite allograft more commonly. The choice to add a nonstructural graft component was reported at 74%. This result was similar for performing multilevel fusions at 72.8%. The selection of nonstructural graft material depends on whether the type of surgery is considered simple or complex. Most surgeons are not satisfied with available literature comparing effectiveness of grafts but believed that there was sufficient evidence to support the use of their chosen graft. Conclusion: Almost all surgeons believe that fusion is important to anterior cervical discectomy and fusion surgery outcomes and that most surgeons believe graft choice affects fusion. However, this survey indicates that there is great variability in the type of graft material used by spine surgeons across the world.

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© 2017, © The Author(s) 2017.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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