Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: A radiographic study

Wewel, Joshua T.; Kasliwal, Manish K.; Adogwa, Owoicho; Deutsch, Harel; O’Toole, John E.; Traynelis, Vincent C.

doi:10.1016/j.jocn.2018.11.040

Cited by 44 publications

(63 citation statements)

References 17 publications

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“…For 3 and 4-level ACDF, higher pseudarthrosis rates were observed [Table 3]. [12,19] Lee et al . (2019) looked at fusion rates for 1-level vs. multilevel ACDF using polyetheretherketone (PEEK) cage-plate fusions in 57 patients followed at least 6 months [Table 3].…”

Section: Introductionmentioning

confidence: 99%

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A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Epstein

2019

Surgical Neurology International

228

167

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Background: There are multiple complications reported for anterior cervical diskectomy and fusion (ACDF), one of the most common cervical spine operations performed in the US (e.g. estimated at 137,000 ACDF/year). Methods: Multiple studies analyzed the risks and complications rates attributed to ACDF. Results: In multiple studies, overall morbidity rates for ACDF varied from 13.2% to 19.3%. These included in descending order; dysphagia (1.7%-9.5%), postoperative hematoma (0.4%-5.6% (surgery required in 2.4% of 5.6%), with epidural hematoma 0.9%), exacerbation of myelopathy (0.2%-3.3%), symptomatic recurrent laryngeal nerve palsy (0.9%-3.1%), cerebrospinal fluid (CSF) leak (0.5%-1.7%), wound infection (0.1-0.9%-1.6%), increased radiculopathy (1.3%), Horner’s syndrome (0.06%-1.1%), respiratory insufficiency (1.1%), esophageal perforation (0.3%-0.9%, with a mortality rate of 0.1%), and instrument failure (0.1%-0.9%). There were just single case reports of an internal jugular veing occlusion and a phrenic nerve injury. Pseudarthrosis occurred in ACDF and was dependant on the number of levels fused; 0-4.3% (1-level), 24% (2-level), 42% (3 level) to 56% (4 levels). The reoperation rate for symptomatic pseudarthrosis was 11.1%. Readmission rates for ACDF ranged from 5.1% (30 days) to 7.7% (90 days postoperatively). Conclusions: Complications attributed to ACDF included; dysphagia, hematoma, worsening myelopathy, recurrent laryngeal nerve palsy, CSF leaks, wound infection, radiculopathy, Horner’s Syndrome, respiratory insufficiency, esophageal perforation, and instrument failure. There were just single case reports of an internal jugular vein thrombosis, and a phrenic nerve injury. As anticipated, pseudarthrosis rates increased with the number of ACDF levels, ranging from 0-4.3% for 1 level up to 56% for 4 level fusions.

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Section: Introductionmentioning

confidence: 99%

“…(2019) also retrospectively evaluated fusion and pseudarthrosis rates for 72 patients undergoing 3 and 4-level ACDF (232 levels fused) [Table 3]. [19] Pseudarthrosis was observed at 47 (14%) total levels, with 45.8% of patients (33/72) exhibiting at least one level that failed to fuse (e.g. typically, the most caudal level).…”

Section: Introductionmentioning

confidence: 99%

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

Epstein

2019

Surgical Neurology International

228

167

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“…The main indication of multilevel ACDF dued to symptomatic multilevel cervical degenerative disc disease with radiculopathy or myelopathy with strict and accurate re ection of neuro-dysfunction on body-dominating area [3,12]. Whether through ACP or SLC system, 3-level ACDF have been proved reliable and effective on decompression, stability and rebuilding of alighment, especially with the more advanced operating-skill and consequently extended sugical-indications on CSM [13]. The newer launched SLC was approved by some researchers for its zero-pro le design, simple inplanation, probable fewer comlications such as dysphagia contrasted to former-born ACP system.…”

Section: Discussionmentioning

confidence: 99%

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

Yang

Liu

et al. 2020

Preprint

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Purpose Cervical alignment between self-locked cage (SLC) and anterior cage-with-plate (ACP) system was debatable, especially in multilevel anterior cervical discectomy and fusion (ACDF). T1 slope minus C2-C7 cervical lordosis (T1S-CL) was critical for cervical-balance while without identified threshold. Thus the study was to compare sagittal alignment between SLC and ACP on 3-level ACDF and to identify the threshold of T1S-CL in 3-level ACDF. Methods 45 patients of 3-level SLC and 28 cases of 3-level ACP with well-matched demographics were retrospectively enrolled with 6.1-year follow-up. Cervical alignment paramters were CL, C2-C7 sagittal vertical axis (C2-C7 SVA), T1S and T1S-CL, as well as adjacent segment degeneration (ASD), obtained on X-ray. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were recorded for evaluating quality of life (QOL). NDI of 20 was difined as the cutoff of QOL. Threshold of T1S-CL was determined by both linear and logistic regression model. Result CL, C2-C7 SVA and T1S were insignificant at baseline and all parameters were indifferent at last (P ˃0.05). CL and T1S improved at last in both groups (P < 0.05). The incidence of ASD was comparable between groups (P ˃0.05). Both groups acquired inprovement on NDI and JOA (P < 0.001). There were close correlation among alignment paramters and between parameters and NDI at final follow-up. C2-C7 SVA was independent risk factor for NDI and two regression models predicted C2-C7 SVA with a cutoff of 29.2 mm, corresponded to the threshold on T1S-CL of 20.7°. Conclusions It is comparable on alignment reconstruction between SLC and ACP system. The cutoff on C2-C7 SVA with 29.2 mm corresponds to a thershold of T1S-CL with 20.7° in multilevel ACDF.

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“…In contrast, pseudarthrosis or implant failure most commonly occurs at the caudal level. 6,15,16 This can be explained by increased shear stress at the level near the cervicothoracic junction. 23 However, the ALOD risk is relatively low at the distal adjacent segment, which emphasizes the need for additional stability at the caudal level, whereas there is less need to increase plate-disc space distance.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Furthermore, pseudarthrosis or implant failure most commonly occur at the caudal-most level. 6,15,16 Therefore, we attempted a hybrid construct using xed screws at the caudal-most instrumented level and variable screws at the cranial and middle levels to prevent ALOD at the proximal adjacent level while minimizing the pseudarthrosis rate at the caudal level. This selective…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Selective Caudal Fixed Screw Construct and All Variable Screw Construct in Anterior Cervical Discectomy and Fusion

Yang

Park

2020

Preprint

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Objectives: This retrospective comparative study aimed to compare the efficacy of selective caudal fixed screw constructs with all variable screw constructs in anterior cervical discectomy and fusion (ACDF). Methods: Thirty-five patients who underwent surgery using selective caudal fixed screw construct (SF group) were compared with 44 patients who underwent surgery using all variable constructs (AV group). The fusion rate, subsidence, adjacent level ossification development (ALOD), adjacent segmental disease (ASD), and plate-adjacent disc space distance were assessed.Results: The one-year fusion rates assessed by computed tomography bone bridging and interspinous motion as well as the significant subsidence rate did not differ significantly between the AV and SF groups. The ALOD and ASD rates and plate-adjacent disc space distances did not significantly differ between the two groups at both the cranial and caudal adjacent levels. The number of operated levels was significantly associated with pseudarthrosis in the logistic regression analysis.Conclusion: The stability provided by the locking mechanism of the fixed screw did not lead to an increased fusion rate at the caudal level. Therefore, the screw type should be selected based on individual patient’s anatomy and surgeon’s experience without concern for increased complications caused by screw type.

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Fusion rate following three- and four-level ACDF using allograft and segmental instrumentation: A radiographic study

Cited by 44 publications

References 17 publications

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

A Review of Complication Rates for Anterior Cervical Diskectomy and Fusion (ACDF)

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

Comparison Between Selective Caudal Fixed Screw Construct and All Variable Screw Construct in Anterior Cervical Discectomy and Fusion

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