Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: Predictive factors for neurological and fusion outcomes

Abstract

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.

Predictive nomogram of cage nonunion after anterior cervical discectomy and fusion: A retrospective study in a spine surgery center

“…Several studies have shown that older age and a history of smoking are risk factors for cage nonunion with ACDF. [7,13,14] Our data is consistent with previous studies which showed the average age of the nonunion group was 62.9 years and the age of the union group was 57.2 years. We also found that cases with the history of smoking had significantly higher rate of nonunion comparing with no smoking (OR = 3.41).…”

Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

“…Direct removal of any disc herniation or osteophyte is possible along with the posterior longitudinal ligament [3]. After decompression however, fusion is usually necessary to restore spinal mechanical stability and integrity [3] and is achieved through the use of tricortical bone autograft [10] and/or implants like mesh cages and plates. Instrumentation may aid alignment correction and fusion of the segments [3].…”

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

“… 42 , 47 One multi-centre consisting of 202 694 patients reported that patients with a history of alcohol abuse were at significantly higher risk of post-operative aspiration. 42 In addition, 2 cohort studies reported that alcohol intake correlated with a delayed timing of fusion after anterior cervical surgery, 48 and hospital readmission. 41 …”

“…42,47 One multi-centre consisting of 202 694 patients reported that patients with a history of alcohol abuse were at significantly higher risk of post-operative aspiration. 42 In addition, 2 cohort studies reported that alcohol intake correlated with a delayed timing of fusion after anterior cervical surgery, 48 and hospital readmission. 41 In addition, a single-centre cohort study of 55 cervical myelopathy patients showed that lower prealbumin levels predicted significantly greater duration of hospital stay and higher risk of postoperative complications, including respiratory failure, skin ulcers, oesophageal perforation and infection.…”