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Purpose: The purpose of this article is to investigate the outcomes after anterior cervical discectomy and fusion (ACDF) surgery with stand-alone tricortical iliac crest autograft and to determine predictive factors for poor neurological recovery, non-union, graft collapse and loss of C2–C7 sagittal alignment. Methods: This was a retrospective study involving patients with cervical myelopathy who underwent ACDF surgery with stand-alone tricortical iliac autograft between 2006 and 2016, with a minimum 2-year postoperative follow-up. Outcomes included the change in Japanese Orthopaedic Association (JOA) scores clinically and timing of fusion, graft height and C2–7 angle measured on lateral radiographs. Any complication such as neurological deterioration, non-union, graft collapse or loss of angle was recorded. Delayed union was considered as radiological union identified only beyond postoperative 6 months. Risk factors including age, smoking, drinking, comorbidities and operative levels were analysed through a multivariate regression for their respective influences on the various outcomes. Results: Of the 69 patients studied, none of the patients had non-union, while 33 (47.1%) achieved fusion in 6 months. The most common complications were anterior protrusion of graft (5.8%) and hoarseness (2.9%). The 1-year mean change in JOA score was 3.9 ± 2.7. The C2–7 angle gradually became more kyphotic, despite an initial lordosis correction intraoperatively. The graft height also gradually collapsed during subsequent follow-ups. Multivariate regression model suggested that diabetics (cumulative odds ratio 7.4) and drinkers (cumulative odds ratio 8.6) were associated with delayed union. Conclusion: ACDF using tricortical iliac crest autograft has satisfactory outcomes with low occurrence of complications. Diabetics and drinkers were predictors of delayed union.

Aims The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS). Methods A comprehensive search was conducted by two independent reviewers on PubMed, Embase, Medline, and Web of Science to obtain all published information on morphological predictors of AIS progression. Search items included ‘adolescent idiopathic scoliosis’, ‘progression’, and ‘imaging’. The inclusion and exclusion criteria were carefully defined. Risk of bias of studies was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. In all, 6,286 publications were identified with 3,598 being subjected to secondary scrutiny. Ultimately, 26 publications (25 datasets) were included in this review. Results For unbraced patients, high and moderate evidence was found for Cobb angle and curve type as predictors, respectively. Initial Cobb angle > 25° and thoracic curves were predictive of curve progression. For braced patients, flexibility < 28% and limited in-brace correction were factors predictive of progression with high and moderate evidence, respectively. Thoracic curves, high apical vertebral rotation, large rib vertebra angle difference, small rib vertebra angle on the convex side, and low pelvic tilt had weak evidence as predictors of curve progression. Conclusion For curve progression, strong and consistent evidence is found for Cobb angle, curve type, flexibility, and correction rate. Cobb angle > 25° and flexibility < 28% are found to be important thresholds to guide clinical prognostication. Despite the low evidence, apical vertebral rotation, rib morphology, and pelvic tilt may be promising factors. Cite this article: Bone Joint J 2022;104-B(4):424–432.