Rigid-plating and cortico-cancellous allograft are effective for 3-level anterior cervical discectomy and fusion: Radiographic and clinical outcomes

• Type of Material: Article
• Authors: Philip K. Louie, Rush University Medical Center; Andrew C. Sexton, Rush University Medical Center; Danel D. Bohl, Rush University Medical Center; Ehsan Tabaraee, Stanislaus Orthopaedic and Sports Medicine; Steven Presciutti, Emory University; Benjamin C. Mayo, University of Illinois at Chicago; Justin C. Paul, Rush University Medical Center; Comron Saifi, University of Pennsylvania; Howard S. An, Rush University Medical Center
• Language: English
• Date: 2020-03-01
• Publisher: World Federation of Neurosurgical Societies-Spine
• Publication Version: Final Published Version
• Copyright Statement: © 2020 by the Korean Spinal Neurosurgery Society.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.14245/ns.1836052.026
• Title of Journal or Parent Work: Neurospine
• Volume: 17
• Issue: 1
• Start Page: 145
• End Page: 155
• Keywords: Bone plates; Allograft; Spinal fusion
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

Objective: To determine the risk factors associated with radiographic changes and clinical outcomes following 3-level anterior cervical discectomy and fusion (ACDF) using rigid-plate constructs and cortico-cancellous allograft. ACDF has demonstrated efficacy for treatment of multilevel degenerative cervical conditions, but current data exists in small hetero-geneous forms. Methods: A retrospective review included 98 patients with primary 3-level ACDF surgery at one institution from 2008 to 2013 with minimum 1-year follow-up. Cervical sagittal ver-tical axis (SVA), segmental height, fusion, and lordosis radiographs were measured preop-eratively and at 2 postoperative periods. Results: Rates of asymptomatic pseudarthroses and total reoperations were 18% and 4%, respectively. Results demonstrated immediate improvements in cervical lordosis (5.5°, p < 0.01) and segmental height (5.0-mm increase, p < 0.01) with little changes in the cervical SVA (3.2-mm increase, p < 0.01). The segmental height decreased from immediate postoperative period to final follow-up (1.7-mm decrease, p < 0.01). Older age was protec-tive against radiolucent lines (p < 0.05). Patient-reported outcomes significantly improved following surgery (p < 0.01). Current smoking status and diagnosis of diabetes mellitus had no impact on radiographic or clinical outcomes. Risk factors were not identified for the 5 reoperations (4%). Conclusion: Three-level ACDF with rigid-plating and cortico-cancellous allograft is an effective procedure for degenerative diseases of the cervical spine without the application of additional adjuncts or combined anteriorposterior cervical surgeries. Significant improvements in cervical lordosis, segmental height, and segmental alignment can be achieved with little change in cervical SVA and a low rate of reoperations over short-term follow-up. Similarly, patient-reported outcomes show significant improvements.