Does Interbody Height and Material Influence Radiographic Pseudarthrosis in ACDF? Insights From a Single-Institution Study.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2025-03-11 DOI:10.1097/BSD.0000000000001797

Brian Hou, Hani Chanbour, Omar Zakieh, Andrew Croft, D Campbell Liles, Iyan Younus, Raymond J Gardocki, Amir M Abtahi, Scott L Zuckerman, Byron F Stephens, Julian G Lugo-Pico

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引用次数: 0

Abstract

Study design: Single-institution retrospective cohort study.

Objective: Determine the impact of graft height and material on radiographic pseudarthrosis, pseudarthrosis requiring reoperation, and patient-reported outcome measures (PROMs).

Summary of background data: The success of an anterior cervical discectomy and fusion (ACDF) depends on obtaining solid bony fusion to achieve stability and restore disc height. While various interbody graft options exist, the impact of graft height and material on fusion rate remains an area of ongoing investigation.

Methods: Patients who underwent 1-3 level primary ACDF between 2010 and 2021 were studied. Graft height and material (structural allograft vs. prosthetics) were the primary independent variables. The primary outcome was pseudarthrosis, defined as interspinous motion >2 mm on flexion-extension lateral x-rays at 1-year postoperatively. PROMs included Numeric Rating Scale-Arm/Neck and Neck Disability Index. Multivariable logistic regression was performed. A subanalysis was conducted for prosthetic submaterial (PEEK vs. titanium).

Results: One hundred fifty-three patients were included (mean age: 51.8±11.0 y; 42.5% male). Most patients had 1-2 levels operated on and 33.3% had structural allograft as the interbody implant. Prosthetic implants were used in 66.7% of patients, with PEEK being the most common (80.4%). At 1-year postoperatively, 11.1% of patients developed pseudarthrosis, and 2.0% underwent reoperation. There were no significant differences in graft height, material, or prosthetic submaterial between patients with and without pseudarthrosis. Multivariable logistic regression also did not show any significant associations between graft height, material, or prosthetic submaterial with pseudarthrosis, reoperation, or PROMs (all P>0.05).

Conclusion: This study found that graft height and material did not significantly affect pseudarthrosis, reoperation, or PROMs in patients undergoing primary ACDF. While graft height and composition alone may not be critical determinants for fusion success in ACDF, Other factors, such as patient-specific characteristics and surgical technique may contribute to the risk of pseudarthrosis and should be explored in future studies.

Level of evidence: Level III.

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.