A prospective comparison of the standard and reverse Robinson cervical grafting techniques: Radiographic and clinical analyses

The authors performed a prospective study of 63 patients with cervical radi culopathy treated with Robinson anterior cervical discectomy and fusion and compared the traditional or standard and reverse graft techniques. Modific ations of the standard Robinson grafting techniques have been proposed. The reverse graft technique has theoretical advantages, including limiting the deleterious effects of graft extrusion and maintaining rigid middle column support. A radiographic evaluation and an assessment of clinical outcome b ased on the criteria of Odom were performed prospectively for as long as 1 year after surgery. Thirty-one patients were treated with the standard graf ting technique and 32 with the reverse,graft orientation. The radiographic evaluation showed no significant differences between the two techniques wit h regard to sagittal alignment and disk heights. The overall fusion grade w as higher in the reverse graft technique (p < 0.05). There were 93% and 96% good to excellent results in the standard graft and reverse graft groups, respectively. The authors report no significant differences associated with the standard or reverse anterior cervical grafting techniques in terms of radiographic alignment or disk height loss over time or at early clinical o utcome. However, improved fusion grade was noted with the reverse graft tec hnique, which may be related to end plate and intervertebral space preparat ion The reverse grafting technique is an acceptable alternative to the stan dard graft orientation.