Lower C2 slope and milder uncovertebral joint degeneration are risk factors for pseudarthrosis after single-level anterior cervical corpectomy and fusion (ACCF): retrospective study of 102 patients with minimum 2-year follow-up.

Abstract

Background: Achieving bony fusion after anterior cervical corpectomy and fusion is crucial for restoring spinal stability; however, the risk factors associated with fusion failure, or pseudarthrosis, remain unclear. This study aims to identify risk factors for pseudarthrosis following anterior cervical corpectomy and fusion and evaluate the impact of C2 slope and uncovertebral joint degeneration on this condition.

Methods: Patients who underwent single-level anterior cervical corpectomy and fusion between May 2015 and April 2022 and had a minimum of 2 years of computed tomography follow-up were retrospectively enrolled. Preoperative demographic, surgical, clinical, and radiographic data were collected. Patients were divided into fusion and pseudarthrosis groups based on fusion status evaluated at the final follow-up computed tomography. After identifying statistically significant variables through intergroup comparisons, multivariate logistic regression analysis was conducted to determine the risk factors for pseudarthrosis.

Results: A total of 102 patients were included in the study, with an average follow-up duration of 3.78 ± 1.70 years. At final follow-up, 37 patients (36.3%) developed pseudarthrosis, while 65 patients (63.7%) achieved fusion. No significant differences were observed in demographic and clinical parameters between the groups. The pseudarthrosis group exhibited significantly greater preoperative C2-7 Cobb angles (p = 0.029), segment range of motion (p < 0.001), lower C2 slope (p < 0.001), and less severe uncovertebral joint degeneration grades (p = 0.001). Multivariate logistic regression analysis revealed that, after adjustment, greater segment range of motion (p = 0.003), lower C2 slope (p = 0.006), and milder uncovertebral joint degeneration grades (p = 0.023) were significant risk factors for pseudarthrosis following single-level anterior cervical corpectomy and fusion. The area under the curve of the regression model was 0.867.

Conclusions: Lower preoperative C2 slope, greater segment range of motion, and milder uncovertebral joint degeneration grades may be risk factors for pseudarthrosis following anterior cervical corpectomy and fusion. These characteristics should be further considered in surgical planning to identify high-risk patients.