An assessment by the BlueCross BlueShield Association Technology Evaluation Center (BCBSA, 2014) stated: "The choice of bone material for interbody fusion in [anterior cervical discectomy and fusion] ACDF has important clinical implications. Allograft bone has several drawbacks, including a minute (albeit unproven) risk of infectious disease transmission; possible immunological reaction to the allograft; and possible limited commercial availability of appropriate graft material. In contrast, the use of autograft bone in ACDF has potentially substantial morbidities at the harvest site, generally the iliac crest. These include moderate-to-severe, sometimes prolonged pain; deep infection; adjacent nerve and artery damage; and increased risk of stress fracture. Although there may be slight differences between autograft and allograft sources in the postoperative rate of union, clinical studies have demonstrated similar rates of postoperative fusion (90%–100%) and satisfactory outcomes for single-level, anterior-plated ACDF using either bone source. Thus, the choice of graft material involves a trade-off between the risks specific to autograft harvest versus those specific to use of allograft material."
Of the 280 total injections, 233 (83%) resulted in pain relief. Patients were more likely to experience pain relief if they presented with multilevel degenerative changes (odds ratio [OR] = , P = .0055), had radicular symptoms in the hand and/or finger (OR = , P = .0011), or underwent injection at the C7-T1 level (OR = , P = .0034). Patients who required narcotics for their symptoms before the procedure showed lower odds of pain relief (OR = , P = .4367). There were no major complications and the overall minor complication rate was %.