***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
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    Input: OBJECTIVE After 40 years of experience with anterior cervical operations , whether to fuse is still controversial . This study seeks to answer this question . METHODS In this prospect i ve r and omized study , we operated on 91 patients with single-level cervical root compression using three different methods : 1 ) discectomy without fusion , 2 ) fusion with autologous bone graft , and 3 ) fusion with autologous bone graft plus plating .  RESULTS After 4 years of follow-up , the radiological results indicated that complete bony union was achieved in almost all cases . A slight kyphosis developed in 62.5 % of the patients who had undergone discectomy , 40 % of the patients who had undergone fusion , and 44 % of the patients who had undergone fusion plus  plating ( not significant ) . The clinical outcomes were good for 76 % of the patients who had undergone discectomy , 82 % who had undergone fusion , and 73 % who had undergone fusion plus plating . The outcomes were poor in 0 , 4 , and 4 % , respectively ( not significant ) . CONCLUSION According to this study , satisfactory results can be achieved by performing simple discectomy to treat single-level cervical root compressive disease OBJECT The authors have previously reported that the results of using cadaveric fibula and locking plate ( CF/LP ) fusion following anterior cervical discectomy ( ACD ) for cervical spondylotic radiculopathy and myelopathy are superior to those obtained using autologous iliac crest ( AIC ) grafts in the short term . The long-term results of using this construct are important in substantiating this improvement . The authors report on 246 consecutive patients ( 54 % smokers ) who underwent ACD with CF/LP fusion ( 175 with allogeneic bone matrix [ ABM ] ) and compare them with 111 consecutive patients in whom AIC fusions ( 49 % smokers ) were performed by the same surgeons . METHODS The study is a retrospective nonr and omized analysis , and chi-square statistics were used . Bone densitometric studies of AIC grafts and CF grafts were performed . A paired t-test was used for statistical analysis of the results . Disease in the group of patients undergoing CF/LP fusion included soft-disc herniation with radiculopathy in 14 , soft-disc hemiation with myelopathy in seven , cervical spondylotic radiculopathy in 144 , cervical spondylotic myelopathy in 75 , AIC graft collapse pseudarthrosis in five , and ACD with no fusion collapse/kyphosis in one . Operations consisted of single-level CF/LP fusion in 142 patients and multilevel CF/LP fusion in 104 . Perioperative complications in the CF/LP group included three cases of transient hoarseness . There were no transfusions , infections , neurological injuries , or deaths . The mean hospital length of stay was 1.2 days ( 28 % outpatient and 66 % 23-hour stay ) . The mean follow-up period was 60 months ( range 12 - 94 months ) . Ten patients were lost to follow up after 1 year . Long-term complications included one traumatic plate fracture and one symptomatic pseudarthrosis with plate fracture . At 1 year and beyond , in 245 ( 99.6 % ) of 246 patients radiographically documented fusion with no motion at the fused level on flexion-extension films was demonstrated . There was no kyphosis , no symptomatic screw plate backout , and no CF/LP graft collapse ( 100 % in the ABM group ) . In the 111 consecutive patients with AIC fusions , however , there was a 17 % graft-related complication rate . There were significantly fewer graft-related complications in the CF/LP group ( p < 0.001 ) . There was no difference in neurological outcome for any of the groups . In the groups undergoing single-level ACD there was a significantly greater chance of complete relief of neck pain  CF/LP fusion compared with those undergoing AIC fusion ( p < 0.02 ) . There was a significantly greater chance of AIC collapse with the passage of time compared with CF graft ( p < 0.02 ) . Time until return to work was shorter for the CF/LP group by 5 to 6 weeks ( p < 0.02 ) . There was a higher rate of radiographically documented pseudarthrosis in the AIC group ( p < 0.006 ) . The mean bone densitometry for the CF/LP group was 0.7 g/cm2 , significantly greater than that of the AIC group , which was 0.2 g/cm2 ( paired t-test p < 0.001 ) . CONCLUSIONS When fusion is necessary following ACD , the results of CF/LP fusion are significantly superior in the first 5 years after surgery compared with those for AIC fusions . It remains to be determined if demineralized ABM has a significant effect in enhancing fusion OBJECT The authors compare clinical outcome and fusion rates after iliac crest autograft (ICAG)- and rectangular titanium cage (RTC)-augmented fusion in patients undergoing anterior cervical discectomy ( ACD ) . METHODS One hundred consecutive patients with 127 levels of cervical disc disease refractory to conservative treatment were r and omized into one of the two treatment groups ( ICAG/RTC fusion ) . The visual analog scale was used by the patient to rate overall pain and head , neck , arm , and donor site pain separately . Myelopathy was documented according to Japanese Orthopaedic Association and Nurick grading systems . Outcome was analyzed using Odom criteria , the 36-Item Short Form ( SF-36 ) , and Patient Satisfaction Index scales . Fusion rates were assessed on st and ard and flexion-extension radiographs . Follow-up data of at least 12 months ' duration were available for 95 patients . More residual overall pain after 12 months was documented in patients who underwent ICAG fusion ( 3.3 + /- 2.5 [ ICAG ] and 2.2 + /- 2.4 [ RTC ] ; p < 0.05 ) . Although arm and head pain were minimal in both groups , neck pain proved to be the predominant symptom ( 2.7 + /- 2.5 [ ICAG ] and 1.9 + /- 2.1 [ RTC ] ) , which resolved in only 67 and 48 % of RTC- and ICAG-treated patients , respectively ( p < 0.05 ) . Myelopathy improved comparably in both groups . Regardless of increased pain in ICAG-treated patients , PSI and SF-36 scores were not significantly different between groups ( only four [ 8 % ] of 47 ICAG-treated patients and five [ 10 % ] of 48 RTC-treated patients were unsatisfied ) . Good to excellent functional recovery according to Odom criteria was observed in 75 and 79 % of ICAG- and RTC-treated patients , respectively . Fusion rates were 81 and 74 % , respectively ( p = 0.51 ) . CONCLUSIONS Fusion rates and clinical outcome at 12 months after ACD were comparable between patients who underwent ICAG and RTC fusion . The use of rectangular cages , however , avoids donor site morbidity and reduces overall pain and , thus , seems to be an advantageous treatment alternative Study Design . This study analyzed the fusion results of an allograft-demineralized bone matrix composite versus autograft in a prospect i ve series of patients undergoing surgery for cervical disc disease . Objectives . To determine the fusion rates of allograft-demineralized bone matrix composite in anterior cervical fusion as compared with the gold st and ard autograft . Summary of Background Data . For the anterior cervical fusion , the use of freeze-dried allograft is well documented in the literature , citing its effectiveness and inferior fusion rates . The use of demineralized bone matrix in conjunction with freeze-dried allograft in anterior cervical fusion has not been reported . Methods . This study was done in a prospect i ve fashion in two medical centers . One group received autograft from the anterior iliac crest , whereas others received freeze-dried allograft augmented with demineralized bone matrix ( Grafton , Osteotech , inc , Shrewsbury , New Jersey ) . For the autograft group , the st and ard Smith-Robinson grafting technique was used . For the allograft composite group , demineralized bone matrix was pasted onto the freeze-dried allograft and into the disc space before graft insertion . The autograft group consisted of 38 patients with age ranging 26–71 years ( mean , 46.1 years ) and follow-up periods of 12–33 months ( mean , 18.4 months ) . There were 19 onelevel , 17 two-level , and two three-level fusions , Similarly , the allograft group consisted of 39 patients with age ranging 28–80 years ( mean , 48.0 years ) with follow-up period of 12–31 months ( mean , 17.5 months ) . There were 19 one-level , 16 two-level , and four three level fusions . Clinical and radiographic follow-up evaluations were completed at 3-month intervals . Radio graphs taken 12 months after surgery were analyzed blindly . Results . Pseudarthrosis developed in 46.2 % of patients ( 33.3 % of levels ) in the allograft-demineralized bone matrix group compared with 26.3 % ( 22 % of levels ) in the autograft group ( p = 0.11 for patients , p = 0.23 for levels ) . For patients undergoing two-level fusions , 37.5 % of allograft-demineralized bone matrix failed compared with 23.5 % of of autografts , for singlelevel fusions , 47.4 % of allograft patients developed a pseudarthrosis compared with 26.3 % in the autograft group . Graft collapse of ≥ 3 mm was noted in 11 % of the autograft group versus 19 % in the allograft-demineralized bone matrix group ( p = 0.32 ) . Graft collapse of ≥ 2 mm occurred in 24.4 % of autograft patients compared with 39.7 % of the allograft-demineralized bone matrix group ( p = 0.09 ) . Smokers had an increased rate of pseudarthrosis ( 47.1 % ) compared with nonsmokers ( 27.9 % , p = 0.13 ) . Conclusions . The study revealed that the allograft-demineralized bone matrix construct gives a higher rate of graft collapse and pseudarthrosis when compared with autograft in a prospect i ve series , although the differences were not statistically significant , The pseudar-throsis rate in the series may be high because of the large percentage of smokers and radiographic evaluation techniques . For the purpose of solid radiographic fusion , the use of autograft is recommended in anterior cervical surgery until other acceptable osteoinductive material s are developed Anterior cervical discectomy and interbody grafting provide excellent results in treating cervical radiculopathy . This prospect i ve study compares the results of the technique obtaining autogenous bone from the cervical vertebrae for grafting to the modified Smith-Robinson technique using autogenous iliac crest graft . Seven levels in six patients were fused using the vertebral body autograft technique and 43 levels in 40 patients using the st and ard technique . All patients had radiculopathy and neck pain .  Statistically significant differences in fusion rate ( 4/7 vertebral body autograft ; 40/43 modified Smith-Robinson ) ( p = 0.029 ) , disc height maintenance ( p = 0.001 ) , and neck pain improvement ( p = 0.05 ) occurred between the techniques . We do not recommend vertebral body autograft over the modified Smith-Robinson technique for anterior cervical fusion following discectomy Abstract This study evaluated whether addition of a cervical spine locking plate ( CSLP ) in two-level disc fusions improved the postoperative stability and reduced the time to healing . Radiostereometric analysis was used to obtain precise recordings of the three-dimensional motion between the fused vertebrae . Eighteen consecutive patients were operated on with excision of two adjacent cervical discs and anterior horseshoe grafting with autologous bone ( Smith Robinson technique ) . Nine patients were r and omized to stabilization with autologous bone grafting and CSLP plate fixation and nine patients to grafting without fixation .  Clinical symptoms in terms of pain in the neck and the arm were analysed preoperatively and after 1 year using a visual analogue scale ( VAS ) . The patients operated without a plate displayed increased rotations around the transverse axis , corresponding to the development of a kyphosis [ mean value no plate/plate 14.4 ° /0.8 ° ( repeated measure ANOVA : P < 0.01 ) ] . The mean compression was 3.2 mm larger in patients operated without a plate ( repeated measure ANOVA : P < 0.01 ) . Patients operated without a plate had more arm pain at the 1-year follow up ( P < 0.05 , Mann-Whitney U test ) . The VAS score for neck pain did not differ significantly between the two groups . Plate fixation could not be demonstrated to increase the healing rate , promote more rapid fusion or influence the frequency of graft complications Study Design . In this study , 43 patients scheduled for a single-level cervical Cloward procedure for disc disease were r and omized prospect ively to fusion with autograft , allograft , or xenograft . Objective . To outline any differences in fusion over time in terms of final mobility and clinical outcome between the three bone grafts . Summary of Background Data . Fusion is used to relieve pain from a spinal segment . The bovine xenograft gives a fibr 
    Output:
    
Few studies reported on pain , therefore , at best , there was very low quality evidence of little or no difference in pain relief between the different techniques .
When the working mechanism for pain relief and functional improvement is fusion of the motion segment , there is low quality evidence that iliac crest autograft appears to be the better technique .
When ignoring fusion rates and looking at complication rates , a cage has a weak evidence base over iliac crest autograft , but not over discectomy alone .