We read this article “A randomized control trial comparing local autografts and allografts in single level anterior cervical discectomy and fusion using a stand-alone cage” by Kanna et al. [1] with interest and had a deliberate discussion at length extensive amongst our peer of spine surgeons. At the outset, we congratulate the authors for a thought-provoking article on a less pondered topic of a common problem and request generous views of our few salient queries.
1. A single-center study inclusive of only 27 patients operated by a single surgeon may be a too-small sample size to conclude on a procedural option for a common cervical spine problem being seen and tackled by spine surgeons [2,3].
2. In the study, 21 patients were diagnosed with radiculopathy and six with myelopathy. In these sub-cohorts, how many underwent local grafting and allograft subsequently and had the two diagnoses potentially skew and bias the study result?
3. The randomization numbers were generated by a computer-generated random chart in this study; how was it ensured that patients falling in the local grafting group would have sufficient osteophytes to fill in the standalone cage being used on them [4]?
4. Is there any specific reason for patients with the American Society of Anesthesiologists grading >3 being excluded from the study?
No potential conflict of interest relevant to this article was reported.
ReferencesKannaRMPerambuduriASShettyAPRajasekaranSA randomized control trial comparing local autografts and allografts in single level anterior cervical discectomy and fusion using a stand-alone cage20211581724MillerLEBlockJESafety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery201136204550FloydTOhnmeissDA meta-analysis of autograft versus allograft in anterior cervical fusion20009398403ParkJIChoDCKimKTSungJKAnterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence20135418993