Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis

Shriver, Michael F.; Lewis, Daniel; Kshettry, Varun R.; Rosenbaum, Benjamin P.; Benzel, Edward C.; Mroz, Thomas E.

doi:10.1016/j.spinee.2015.05.010

Cited by 158 publications

(136 citation statements)

References 34 publications

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“…Common reasons for secondary surgeries after ACDF in most randomized trials are pseudarthrosis and ASD. In this study, ASD was also the most common reason for a new intervention in the ACDF group, while intervention for pseudarthrosis was less than 1% which is lower than found in another retrospective study of 672 patients [23], but consistent with other publications [24,25]. A majority of patients in this cohort were treated with iliac crest bone and plating which might create better conditions for healing than alternative methods [26][27][28].…”

Section: Discussionsupporting

confidence: 86%

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

2017

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Purpose To evaluate rates of secondary surgical interventions in a cohort treated with fusion (ACDF), artificial disc replacement (ADR) or a posterior surgical procedure (PP) because of a cervical degenerative pathology. Methods 715 patients treated with any primary cervical surgical intervention between the years 2000 and 2010 were retrospectively evaluated regarding frequency of secondary surgery between the years 2000 and 2015, thus giving a follow-up time of minimum 5 years. Reasons for secondary surgery as well as choice of new intervention were evaluated. Data were collected from a single-center setting. Results Follow-up rate was 94%. 79 (11%) patients in total underwent a new operation during follow-up. 50/504 (10%), 27/172 (15%), and 2/39 (5%) of the patients had a second surgical intervention in the ACDF, ADR, and PP groups, respectively. There was a statistically significant higher rate of repeated surgery in the ADR group compared to the ACDF group, OR 1.7 (CI 1.06-2.8), p = 0.03. Risk for repeated surgery at index level was even higher for ADR, OR 5.1 (CI 2.4-10.7), p \ 0.001. Reoperation rate because of ASD in the whole cohort did not differ between ACDF and ADR groups, p = 0.40. ConclusionThe group initially treated with artificial disc replacement showed higher rate of reoperations and more implant-related complications. In this cohort, artificial disc replacement was not protective against reoperation because of adjacent segment pathology.

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Section: Discussionsupporting

confidence: 86%

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

2017

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“…Third, only one of 12 studies used an autograft; the other 11 used allografts. An autograft provides better conditions for bone fusion and a higher fusion rate compared with allograft [15,36]. The use of allografts could increase the risk of pseudarthrosis and the frequency of reoperation in the control group.…”

Section: Discussionmentioning

confidence: 99%

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Zhong

Zhu

Zhuang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Anterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare cervical disc arthroplasty with anterior cervical discectomy and fusion regarding (1) the overall frequency of reoperation at the index and adjacent levels; (2) the frequency of reoperation at the index level; and (3) the frequency of reoperation at the adjacent levels. Methods PubMed, EMBASE, and the Cochrane Register of Controlled Trials databases were searched to identify RCTs comparing cervical disc arthroplasty with anterior cervical discectomy and fusion and reporting the frequency of reoperation. We also manually searched the reference lists of articles and reviews for possible relevant studies. Twelve RCTs with a total of 3234 randomized patients were included. Eight types of disc prostheses were used in the included studies. In the anterior cervical discectomy and fusion group, autograft was used in one study and allograft in 11 studies. Nine of 12 studies were industry sponsored. Pooled risk ratio (RR) and associated 95% CI were calculated for the frequency of reoperation using random-effects or fixed-effects models depending on the heterogeneity of the included studies. A funnel plot suggested the possible presence of publication bias in the available pool of studies; that is, the shape of the plot suggests that smaller negative or nodifference studies may have been performed but have not been published, and so were not identified and included in this meta-analysis. Results The overall frequency of reoperation at the index and adjacent levels was lower in the cervical disc arthroplasty group (6%; 108/1762) than in the anterior cervical discectomy and fusion group (12%; 171/1472) (RR, 0.54; 95% CI, 0.36-0.80; p = 0.002). Subgroup analyses were performed according to secondary surgical level. Compared with anterior cervical discectomy and fusion, cervical disc arthroplasty was associated with fewer reoperations at the index level (RR, 0.50; 95% CI, 0.37-

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“…Patients undergoing multilevel fusion are at a higher risk for pseudarthrosis postoperatively than patients undergoing single level fusion [56]. While reported rates of pseudarthrosis for ACDF vary in literature, previous studies have consistently shown an inverse correlation with fusion rate and the number of levels being fused [78].…”

Section: Discussionmentioning

confidence: 99%

Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients

Divi

Mikhael

2017

Asian Spine J

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Study DesignRetrospective case series.PurposeTo report our early experience using allogenic mesenchymal cellular bone matrix (CBM) products in cervical spine fusion.Overview of LiteratureMulti-level cervical fusions have historically yielded lower fusion rates than single level fusions, especially in patients with high risk medical comorbidities. At this time, significant literature in cervical fusion outcomes with this cellular allograft technology is lacking.MethodsTwenty-one patients underwent either multilevel (3 or 4 level) anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical fusion. ViviGen (DePuy Synthes Spine, Raynham, MA, USA), an allogenic bone matrix product, was used in addition to standard instrumentation. Radiographic evaluation was performed at 2 weeks, 12 weeks, 24 weeks and 1 year postoperative. Visual analog scale (VAS) and neck disability index (NDI) scores along with return to work and leisure activity were recorded.ResultsAt 6 months postoperative, all patients had radiographic evidence of bone fusion regardless of age or medical comorbidities. All patients reported subjective improvement with a mean decrease in VAS from 8.3 to 1.5 and a mean decrease in NDI from 40.3% to 6.0% at 1 year. All patients also returned to work and/or regular leisure activity within 3 months.ConclusionsTwenty-one patients undergoing high-risk anterior and posterior cervical spine fusion, with the use of a commercially available mesenchymal CBM product, went on to radiographic fusion and all had improvement in subjective outcomes. While further effort and research is needed to validate its widespread use, this study shows favorable use of CBM in cervical fusion for high-risk cases.

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Pseudoarthrosis rates in anterior cervical discectomy and fusion: a meta-analysis

Cited by 158 publications

References 34 publications

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Higher reoperation rate following cervical disc replacement in a retrospective, long-term comparative study of 715 patients

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Use of Allogenic Mesenchymal Cellular Bone Matrix in Anterior and Posterior Cervical Spinal Fusion: A Case Series of 21 Patients

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