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Asian Spine J > Volume 16(2); 2022 > Article
Rawat and Kumar: Letter to the Editor: A Randomized Control Trial Comparing Local Autografts and Allografts in Single Level Anterior Cervical Discectomy and Fusion Using a Stand-Alone Cage
Dear Editor,
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?

Conflict of Interest

No potential conflict of interest relevant to this article was reported.


1. Kanna RM, Perambuduri AS, Shetty AP, Rajasekaran S. A randomized control trial comparing local autografts and allografts in single level anterior cervical discectomy and fusion using a stand-alone cage. Asian Spine J 2021;15:817–24.
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2. Miller LE, Block JE. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976) 2011;36:2045–50.
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3. Floyd T, Ohnmeiss D. A meta-analysis of autograft versus allograft in anterior cervical fusion. Eur Spine J 2000;9:398–403.
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4. Park JI, Cho DC, Kim KT, Sung JK. Anterior cervical discectomy and fusion using a stand-alone polyetheretherketone cage packed with local autobone : assessment of bone fusion and subsidence. J Korean Neurosurg Soc 2013;54:189–93.
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