Anterior Cervical Discectomy and Fusions Supplemented With Cellular or Noncellular Allografts Have Similar Radiographic Fusion and Clinical Outcomes.
Clinical spine surgery
STUDY DESIGN: A retrospective, single-center study.
OBJECTIVE: The aim of this study was to assess radiographic fusion after anterior cervical discectomy and fusion (ACDF) supplemented with either demineralized bone matrix or ViviGen in a polyetheretherketone biomechanical interbody cage.
SUMMARY OF BACKGROUND DATA: Cellular and noncellular allografts are utilized as adjuncts in attempts to improve fusion after ACDF. The purpose of this study was to assess radiographic fusion and clinical outcomes after ACDF supplemented with cellular or noncellular allografts.
MATERIALS AND METHODS: A single surgeon's clinical practice database was interrogated for consecutive patients who underwent a primary ACDF using cellular or noncellular allograft from 2017 to 2019. These subjects were matched by age, sex, body mass index, smoking status, and levels operated. Patient demographic and preoperative and postoperative patient-reported outcome measures (PROMs) including Visual Analog Scale Pain, Neck Disability Index, EuroQol-5 Dimension (EQ-5D), Patient-Reported Outcomes Measurement Information System (PROMIS), and Eating Assessment Tool 10 were collected preoperatively and at 3, 6, and 12 months postoperatively. Radiographic evidence of fusion was determined by3, 6, and 12 months postoperatively.
RESULTS: There were 68 total patients, with 34 patients in each group, and 69 and 67 operative levels in the cellular and noncellular allograft groups, respectively. There was no difference in age, sex, body mass index, or smoking status between groups (P>0.05). There was no difference in number of 1-level, 2-level, 3-level, or 4-level ACDFs between cellular and noncellular groups (P>0.05). At 3, 6, and 12 months postoperatively, there was no difference in the percent of operated levels withprocesses, complete bony bridging, or both(P>0.05). There was no difference in the number of patients fused at all operated levels at 3, 6, or 12 months postoperatively (P>0.05). No patient required revision ACDF for symptomatic pseudarthrosis. There was no significant difference in PROMs between the cellular and noncellular groups at 12 months postoperatively except for improved EQ-5D and PROMIS-physical in the cellular compared with noncellular group (P=0.03).
CONCLUSIONS: Similar radiographic fusion rates were achieved with cellular and noncellular allografts at all operated levels with similar PROMs in the cellular and noncellular groups at 3, 6, and 12 months postoperatively. Thus, ACDFs supplemented with cellular allograft demonstrate adequate radiographic fusion rates when compared with noncellular allografts with similar patient outcomes.
LEVEL OF EVIDENCE: Level III.
Zakko P, Blankenship A, Jawad A, Kasir R, Lee M, Park D. Anterior cervical discectomy and fusions supplemented with cellular or noncellular allografts have similar radiographic fusion and clinical outcomes. Clin Spine Surg. 2023 Jun 20. doi: 10.1097/BSD.0000000000001475. Epub ahead of print. PMID: 37381143.