Cages in ACDF are Associated With a Higher Nonunion Rate Than Allograft: A Stratified Comparative Analysis of 6130 Patients. Issue 6 (15th March 2019)

• Record Type: Journal Article
• Authors: Pirkle, Sean; Kaskovich, Samuel; Cook, David J.; Ho, Alisha; Shi, Lewis L.; Lee, Michael J.
• Is Part Of: Spine. Volume 44:Issue 6(2019)
• Publication Date: 2019-03-15
• Subjects: ACDF -- allograft -- anterior cervical discectomy and fusion -- cervical spine -- fusion rate -- intervertebral cage -- nonunion -- PEEK cage; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000002854
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective database review. Objective: The purpose of this study was to analyze the rate of nonunion in patients treated with structural allograft and intervertebral cages in anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Existing literature consists primarily of single-center studies with inconsistent findings. Methods: We performed a retrospective analysis of 6130 patients registered in the PearlDiver national database through Humana Insurance from 2007 to 2016. All ACDF patients with anterior plating who were active in the database for at least 1 year were included in the study. Patients with a fracture history within 1 year of intervention, past arthrodesis of hand, foot, or ankle, or a planned posterior approach were excluded from the study. Patients were stratified by number of levels treated, tobacco use, and diabetic condition. Nonunion rates of structural allograft and intervertebral cage groups after 1 year were compared using Chi-squared analyses. Results: Four thousand sixty-three patients were included in the allograft group, while 2067 were included in the cage group. Overall nonunion rates were significantly higher in the cage group (5.32%) than in allograft group (1.97%) ( P < 0.01). When controlling for confounders, increased rates of nonunion were consistently observed in the cage group, achieving statistical significance in 25 of the 26 analyses. Conclusion: The increased rate of nonunion associated with intervertebral cages may suggest the superiority of allograft over cages in ACDF. Level of Evidence: 3 Abstract : Supplemental Digital Content is available in the textThe long-term success of anterior cervical discectomy and fusion is associated with solid fusion. In this study, we found that both anterior cervical discectomy and fusion with structural allograft and cage have high fusion rates. However, these data suggest that the use of a cage is associated with a significantly higher rate of nonunion as compared to structural allograft.