Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-06-08DOI: 10.1177/21925682251350941
Vanessa Hubertus, Jetan H Badhiwala, Nader Hejrati, Aria Nouri, Paula V Ter Wengel, Farzin Farahbakhsh, Christoph Hofstetter, Chris J Neal, Mario Ganau, Nitin Agarwal, Paul Arnold, Paul Koljonen, James Harrop, Bizhan Aarabi, James Guest, Ricardo Rodrigues-Pinto, Michael G Fehlings, Nathan Evaniew, Konstantinos Margetis, Daipayan Guha, Lukas Grassner, Brian K Kwon, Charles G Fisher, Shekar Kurpad, On Behalf Of The Ao Spine Knowledge Forum Spinal Cord Injury
{"title":"AO Spine Clinical Practice Recommendations for the Surgical Management of Acute Traumatic Spinal Cord Injury: Contemporary Concepts.","authors":"Vanessa Hubertus, Jetan H Badhiwala, Nader Hejrati, Aria Nouri, Paula V Ter Wengel, Farzin Farahbakhsh, Christoph Hofstetter, Chris J Neal, Mario Ganau, Nitin Agarwal, Paul Arnold, Paul Koljonen, James Harrop, Bizhan Aarabi, James Guest, Ricardo Rodrigues-Pinto, Michael G Fehlings, Nathan Evaniew, Konstantinos Margetis, Daipayan Guha, Lukas Grassner, Brian K Kwon, Charles G Fisher, Shekar Kurpad, On Behalf Of The Ao Spine Knowledge Forum Spinal Cord Injury","doi":"10.1177/21925682251350941","DOIUrl":"10.1177/21925682251350941","url":null,"abstract":"<p><p>Study DesignReview of the literature with critical appraisal and clinical recommendations.ObjectiveTo highlight contemporary concepts relating to surgical care for acute traumatic spinal cord injury (SCI) based on recent evidence that may be integrated into clinical practice.MethodsThree recent articles relating to the surgical management of acute traumatic SCI were selected and critically appraised. Clinical practice recommendations were developed and graded as strong or conditional.ResultsArticle 1: Early vs late surgical decompression for central cord syndrome. Strong recommendation to consider early surgery (<24 hours) as an option in patients with ASIA Impairment Scale (AIS) grade C central cord syndrome. Article 2: Extent of decompression in motor complete SCI. Conditional recommendation to consider laminectomy, with or without anterior surgery, to achieve circumferential decompression of the spinal cord. Article 3: Use of intra-operative ultrasound. Conditional recommendation to use ultrasound intra-operatively to confirm the adequacy of surgical decompression.ConclusionsTimely and adequate decompression of the spinal cord are critical priorities in the management of acute traumatic SCI. The importance of timeliness extends to central cord syndrome. Careful consideration and use of operative techniques (e.g., addition of laminectomy) and adjuncts (e.g., intra-operative ultrasound) help achieve safe and adequate decompression of the spinal cord.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3572-3579"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12146309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-03-13DOI: 10.1177/21925682251325823
Charles N de Leeuw, Won Hyung Andrew Ryu, Jung Yoo, Josiah N Orina
{"title":"Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy: Patient Characteristics and Surgical Outcomes in a National Administrative Database.","authors":"Charles N de Leeuw, Won Hyung Andrew Ryu, Jung Yoo, Josiah N Orina","doi":"10.1177/21925682251325823","DOIUrl":"10.1177/21925682251325823","url":null,"abstract":"<p><p>Study DesignA retrospective cohort utilizing the PearlDiver Patient Claims Database.ObjectiveCervical disc arthroplasty (CDA) is accepted treatment for cervical radiculopathy; however, it may also be safe and effective in myelopathy. Thus, we compared clinical characteristics and outcomes in patients undergoing CDA and anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) specifically.MethodsPatients undergoing CDA or ACDF between 2015-2019 were identified with follow-up through 2021. Univariate and multivariable analyses were performed to identify factors associated with either procedure. Reoperation rates were compared using propensity-matched analysis.ResultsWe identified n = 2391 CDA and n = 50 845 ACDF procedures for DCM. Factors favoring CDA included: female sex, younger age, lower CCI, lower incidence of obesity, osteoporosis, diabetes, or smoking (<i>P</i> ≤ .001); remaining significant after multivariable logistic regression except for sex (<i>P</i> = .06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and multi-level surgery; all remaining significant after multivariable analysis except for diabetes (<i>P</i> = .23) and CCI (<i>P</i> = .05). After propensity-matching CDA and ACDF patients (n = 2391), there was no difference in re-operation rates (<i>P</i> = .47).ConclusionsCDA patients were healthier (less obesity, smoking, diabetes, better CCI) and represented 4.5% of anterior procedures for DCM. In univariate analysis, readmission rates, medical complications, and opioid use were lower in CDA patients, despite a similar reoperation rate. Considering these findings, CDA might be used very selectively for DCM.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3637-3647"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgeon-Guided Fluoroscopic Erector Spinae Plane Block (ESPB) versus Anesthetist-Guided Ultrasonic ESPB for Perioperative Analgesia in Lumbar Fusion Surgery- a Prospective Randomized Control Study.","authors":"Gnanaprakash G, Rishi Mugesh Kanna, J Balavenkat Subramanian, Sekar Chelliah, Ajoy Prasad Shetty, S Rajasekaran","doi":"10.1177/21925682251333407","DOIUrl":"10.1177/21925682251333407","url":null,"abstract":"<p><p>Study designProspective, randomized control study.ObjectiveTo assess the safety and efficacy of fluoroscopy-guided vs ultrasound-guided Erector Spinae Plane Block (ESPB) for perioperative analgesia in lumbar fusion surgery.Materials and Methods66 patients requiring single-level lumbar fusion were randomized into 2 groups. One group had fluoroscopy-guided ESPB by the surgeon (Fluoro-ESPB group) and the other group had Ultrasound-guided ESPB by the anesthetist (USG-ESPB). Demographic details, intraoperative parameters (perioperative total opioid consumption, muscle relaxants used, heart rate, blood pressure), and postoperative parameters (VAS score, alertness, satisfaction score) were recorded and analyzed.ResultsDuring the initial 48 hours following the surgery, both groups provided good perioperative analgesia, and reported very low and comparable postoperative pain scores (VAS scale). The mean VAS score was 2.7 ± 0.5 in the Fluoro-ESPB group and 2.7 ± 0.5 in the USG-ESPB group (<i>P</i> = 0.91). The average time taken to deliver the block in the Fluoro-ESPB group (3.01 ± 0.97 mins) was significantly less than in the USG-ESPB group (4.74 ± 1.49 mins) (<i>P</i> = 0.00). The total perioperative opioid consumption (TOC), total intraoperative muscle relaxant consumption, and intraoperative blood loss were similar in both groups (Fluoro- ESPB, USG ESPB) (<i>P</i> > 0.05). The postoperative MOASS score was consistently high across both groups. The satisfaction scores were high and comparable (<i>P</i> = 0.403).ConclusionThe fluoroscopy-guided ESPB is a safe and effective alternative to the traditional ultrasound-guided technique. It can be performed by the surgeon, reducing overall procedure time, and improving workflow.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3834-3843"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-04-03DOI: 10.1177/21925682251333703
Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee
{"title":"Relationship of T10-Pelvic Angle With Conventional Sagittal Parameters and Legacy Alignment Schemes in Adult Spinal Deformity Surgery.","authors":"Se-Jun Park, Hyun-Jun Kim, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.1177/21925682251333703","DOIUrl":"10.1177/21925682251333703","url":null,"abstract":"<p><p>Study DesignRetrospective analysis.ObjectiveTo investigate the relationship of T10-pelvic angle (T10PA) with conventional sagittal parameters and legacy alignment schemes.Summary of Background DataT10PA is a newly introduced sagittal parameter to predict the development of proximal junctional kyphosis (PJK). However, its relationship with conventional sagittal parameters and legacy alignment schemes remains unknown.MethodsPatients with fusion from the pelvis to the upper-instrumented vertebra at or above the T10 were included. Based on the 6-week T10PA, the patients were divided into 3 groups as follows: undercorrection, functional alignment, and overcorrection. Conventional sagittal parameters and alignment status based on the Schwab's pelvic incidence (PI)-lumbar lordosis (LL) modifiers and age-adjusted PI-LL were compared according to the T10PA groups. The PJK rates were compared among the alignment schemes.ResultsOverall, 219 patients were enrolled in this study. At 6 weeks postoperatively, 33.3%, 37.0%, and 29.7% of the patients demonstrated undercorrection, functional alignment, and overcorrection relative to the T10PA, respectively. Conventional sagittal parameters significantly differed according to the T10PA groups. Linear regression analysis revealed that T10PA was significantly affected by PI (β = .562) and LL (β = - .411). The correction statuses of the Schwab's PI-LL modifiers and age-adjusted PI-LL were significantly differentiated between the T10PA correction groups. However, only 32.9% of patients with functional alignment relative to T10PA belonged to matched correction category for the age-adjusted PI-LL. Overcorrection relative to age-adjusted PI-LL and T10PA significantly increased PJK risks.ConclusionT10PA significantly correlated with conventional sagittal parameters, particularly PI and LL. Although the T10PA correction status correlated with that of the legacy alignment schemes, a notable discrepancy in the optimal correction was observed between the T10PA and age-adjusted PI-LL schemes. Overcorrection relative to T10PA and age-adjusted PI-LL should be avoided to mitigate PJK development.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3844-3852"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11969490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-04-14DOI: 10.1177/21925682251334122
Henry Avetisian, Mirbahador Athari, William Karakash, Jordan O Gasho, Matthew C Gallo, Jeffrey C Wang, Raymond J Hah, Ram K Alluri
{"title":"Staged Versus Same-Day Circumferential Lumbar Fusion for Degenerative Disease: Which is the Safer Approach?","authors":"Henry Avetisian, Mirbahador Athari, William Karakash, Jordan O Gasho, Matthew C Gallo, Jeffrey C Wang, Raymond J Hah, Ram K Alluri","doi":"10.1177/21925682251334122","DOIUrl":"10.1177/21925682251334122","url":null,"abstract":"<p><p>Study DesignRetrospective cohort study.ObjectivesTo evaluate utilization trends and outcomes of same-day vs staged circumferential lumbar fusion (cLF) in lumbar degenerative disease.MethodsThe PearlDiver national database was queried for patients with lumbar degenerative disease who underwent same-day or staged cLF, defined as anterior lumbar interbody fusion followed by posterior fusion within 1 to 14 days after. Annual utilization trends (2010-2021) were analyzed. Multivariate regression adjusted for age, gender, comorbidity index, obesity, smoking, and multi-level PSF was used to evaluate 30-day complications, readmissions, and revision rates at 1 and 2 years.ResultsOf 45,204 patients undergoing cLF, 40,052 (88.60%) underwent same-day cLF, and 5152 (11.40%) underwent staged procedures. Patients who underwent staged procedures had higher comorbidity rates and longer fusion constructs. Annual utilization of staged cLF increased on average by 3.76% from 2010. Staged procedures had higher risks of 30-day readmissions (aOR: 1.14), infection (aOR: 1.38), DVT (aOR: 2.62), epidural hematoma (aOR: 1.73), seroma (aOR:1.77), AKI (aOR: 1.34), cardiac arrest (aOR: 2.45), blood loss anemia (aOR: 1.56), urinary retention (aOR: 1.50), UTI (aOR: 1.36), ileus (aOR: 1.64), durotomy (aOR: 4.67), mechanical complications (aOR: 3.39), and blood transfusions (aOR: 2.57) (all <i>P</i> < 0.05). No significant differences in revision rates were found.ConclusionStaged cLF, utilized in 11.40% of cases, particularly for longer fusions and patients with higher comorbidity risk, is associated with higher risks of hospital readmissions and complications, but is not an independent risk factor. Further research is needed to identify patients who may benefit most from staging.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3861-3868"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11996812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-03-28DOI: 10.1177/21925682251333324
Paul G Mastrokostas, Mohamed Said, Christian Cassar, Leonidas E Mastrokostas, Aaron B Lavi, Arya Varthi, Jad Bou Monsef, Afshin E Razi, Mitchell K Ng
{"title":"Obstructive Sleep Apnea is Associated With Increased Rates of Acute Respiratory Failure, Length of Stay, and Hospital Costs in Patients Undergoing Elective Single-Level Anterior Cervical Discectomy and Fusion.","authors":"Paul G Mastrokostas, Mohamed Said, Christian Cassar, Leonidas E Mastrokostas, Aaron B Lavi, Arya Varthi, Jad Bou Monsef, Afshin E Razi, Mitchell K Ng","doi":"10.1177/21925682251333324","DOIUrl":"10.1177/21925682251333324","url":null,"abstract":"<p><p>Study designRetrospective cohort study.ObjectivesTo examine differences in postoperative complications, recovery course, and costs between patients with and without obstructive sleep apnea (OSA) undergoing single-level anterior cervical discectomy and fusion (ACDF).MethodsThe National Inpatient Sample (NIS) database was queried to identify patients undergoing single-level ACDF between 2016 and 2022. After exclusions, patients were divided into OSA and control groups. Propensity score matching (1:2) controlled for age, sex, obesity, and year of surgery to balance characteristics. Postoperative outcomes, including complications, length of stay (LOS), hospital costs, and discharge disposition, were compared using chi-square tests for categorical variables and t-tests for continuous variables. A Bonferroni correction was applied, with significance set at <i>P</i> < 0.002.ResultsA total of 36,000 matched cases were analyzed (12,000 OSA and 24,000 controls). OSA patients had significantly higher rates of acute respiratory failure (4.7% vs 1.9%; <i>P</i> < 0.001) and mechanical ventilation (1.5% vs 0.6%; <i>P</i> < 0.001). The OSA cohort also had a longer LOS (2.3 vs 1.9 days; <i>P</i> < 0.001), higher hospital costs ($23,300 vs $21,100; <i>P</i> < 0.001), and greater non-routine discharge rates (20.4% vs 16.8%; <i>P</i> < 0.001).ConclusionsOSA is associated with increased respiratory complications, prolonged LOS, and higher costs in single-level ACDF. These findings underscore the importance of preoperative screening and tailored perioperative management to improve outcomes in this high-risk population.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3827-3833"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Analysis of the Predictive Efficiency of Lumbar Vertebral Body Quantification (VBQ) and CT Hounsfield Units (HUs) for Bone Density: Age and Gender Differences.","authors":"Xianghe Wang, Minghang Chen, Chenjie Shan, Xiang Fang, Chaohui Ding, Zongjie Yuan, Honglin Teng","doi":"10.1177/21925682251334985","DOIUrl":"10.1177/21925682251334985","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectiveThis study examines the consistency of Vertebral Bone Quality (VBQ) and Computed Tomography Hounsfield Units (CT HUs) with Dual-energy X-ray absorptiometry (DXA) as a reference standard, evaluating the diagnostic performance of these 2 imaging techniques across different age groups and genders. Particular attention is given to the applicability of VBQ in different age and gender cohorts.MethodsWe included 972 eligible patients, from which 569 patients were randomly selected and included in the analysis according to the inclusion criteria. These patients underwent lumbar Magnetic Resonance Imaging (MRI), lumbar CT, and DXA within 3 months of hospital admission. The study assessed the correlation and diagnostic efficacy of these techniques in measuring lumbar and femoral neck bone mineral density (BMD).ResultsIt showed good correlation between VBQ and CT HUs with DXA in individuals under 70 years of age. However, in the population over 70 years, the correlation of VBQ with DXA significantly decreased (lumbar BMD pr = -.145 <i>P</i> > .05; femoral neck BMD r = -.097 <i>P</i> > .05), whereas CT HUs maintained high diagnostic performance. The ROC curve analysis indicated that the AUC for differentiating osteoporosis (based on lumbar spine BMD) by VBQ was .545 in males over 70 and .487 in females over 70. However, CT HUs demonstrated diagnostic performance across all groups.ConclusionVBQ is effective in assessing osteoporosis in patients under 70 but shows decreased efficacy in those over 70. When using VBQ to predict osteoporosis in patients on opportunistic grounds, it is still necessary to incorporate additional reference indicators, such as CT HUs.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3869-3880"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12075167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Global Spine JournalPub Date : 2025-11-01Epub Date: 2025-04-14DOI: 10.1177/21925682251329228
Eric R Zhao, Robert Kamil, Austin C Kaidi, Jung K Mok, Yousi Oquendo, Olatunde Badejo, Troy B Amen, Gregory S Kazarian, Tomoyuki Asada, Arsen M Omurzakov, Tim Xu, Tejas Subramanian, Nathan H Varady, Mitchell A Johnson, Bo Zhang, Mitchell S Fourman, Kyle W Morse, Francis C Lovecchio, Sravisht Iyer, James E Dowdell, Han Jo Kim, Sheeraz A Qureshi
{"title":"Zero-Profile Stand-Alone Cages Versus Traditional Cage-and-Plate Constructs in Single and Multi-Level Anterior Cervical Discectomy and Fusion: A Propensity-Matched Analysis Using Validated Fusion Assessment Methods.","authors":"Eric R Zhao, Robert Kamil, Austin C Kaidi, Jung K Mok, Yousi Oquendo, Olatunde Badejo, Troy B Amen, Gregory S Kazarian, Tomoyuki Asada, Arsen M Omurzakov, Tim Xu, Tejas Subramanian, Nathan H Varady, Mitchell A Johnson, Bo Zhang, Mitchell S Fourman, Kyle W Morse, Francis C Lovecchio, Sravisht Iyer, James E Dowdell, Han Jo Kim, Sheeraz A Qureshi","doi":"10.1177/21925682251329228","DOIUrl":"10.1177/21925682251329228","url":null,"abstract":"<p><p>ObjectivesStand-alone (SA) and anterior cage-and-plate (ACP) have been studied in anterior cervical discectomy and fusion (ACDF). However, fusion assessment methods vary and existing studies are not propensitymatched and often lack patient-reported outcomes (PROMs). We compare fusion rates between propensity-matched single- and multi-level SA versus ACP using a method validated by intraoperative motion testing during revision surgery. We also compare sagittal alignment, perioperative outcomes, and PROMs.MethodsPatients >18 years who underwent primary ACDF were included. 2:1 propensity score matching was performed. Fusions were assessed using 1 year computer tomography and flexion/extension radiographs via validated fusion assessment methods. ALOD was assessed at least 6-months postoperatively. Sagittal alignment was assessed at preoperative, short-term postoperative (2-6 weeks), and long-term postoperative (6 months or more) time points. PROMs, operative time, blood loss, dysphagia, and complications were analyzed.Results153 patients (51 SA) were included after matching. There were no differences in fusion rates overall (<i>P</i> = .662), or by number of surgical levels. There were no differences in ALOD at upper or lower levels, nor was there a difference in ALOD grade. Regarding segmental lordosis, overall lordosis, T1 slope, TS-CL, and PROMs (NDI, SF-12 PCS, VAS neck and arm), there were no differences at preoperative or any postoperative time point. Operative time and blood loss were greater in the ACP cohort, with no differences in complications or postoperative dysphagia.ConclusionsFusion rates, PROMs, radiographic outcomes, complications, and dysphagia rates were all comparable following single and multi-level ACDF between SA and ACP.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"3679-3691"},"PeriodicalIF":3.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}