Sanjay Singh Rawat1, Vishal Kumar2. 1. Trauma and Emergency (Orthopaedics), All India Institute of Medical Sciences, Raipur, India. 2. Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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?