Structural Allograft Versus Synthetic Interbody Cage for Anterior Cervical Discectomy and Fusion: A Comparison of 1-Year Outcomes From a National Database

Abstract

Study Design: Observational cohort study. Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database. Methods: The TriNetX Research Network was retrospectively queried. Patients undergoing initial single or multilevel ACDF surgery between October 1, 2015 and April 30, 2019 were propensity score matched based on age and comorbidities. The rates of 1-year revision ACDF surgery and reported diagnoses of pseudoarthrosis, surgical site infection (SSI), and dysphagia were compared between structural allograft and synthetic cage techniques. Results: A comparison of 1-year outcomes between propensity score matched cohorts was conducted on 3056 patients undergoing single-level ACDF and 3510 patients undergoing multilevel ACDF. In single-level ACDF patients, there was no difference in 1-year revision ACDF surgery ( P = .573), reported diagnoses of pseudoarthrosis ( P = .413), SSI ( P = .620), or dysphagia ( P = .529) between SA and SC groups. In multilevel ACDF patients, there was a higher rate of revision surgery (SA 3.8% vs SC 7.3%, odds ratio = 1.982, P < .001) in the SC group, and a higher rate of dysphagia in the SA group (SA 15.9% vs SC 12.9%). Conclusion: While the overall revision and complication rate for single-level ACDF remains low despite interbody graft selection, SC implant selection may result in higher rates of revision surgery in multilevel procedures despite yielding lower rates of dysphagia. Further prospective study is warranted.

The Impact of the COVID-19 Pandemic on Orthopaedic Knee Procedures: A National Multicentered Analysis

“…Most participating institutions provide data dating back to the last seven years. TriNetX has been previously used in other orthopaedic studies [ 12 , 13 ].…”

A Five-Year Cost-Utility Analysis Comparing Synthetic Cage Versus Allograft Use in Anterior Cervical Discectomy and Fusion Surgery for Cervical Spondylotic Myelopathy

“…Although more than one study suggested a higher revision rate for SC, our assumptions were based on Marrache and colleagues, which compared all-cause, two-year reoperation rates after ACDF between Allo (8% in 11,514 patients) and SC (9.1% in 15,240 patients). 13,15 The second study by Veeravagu et al 14 provided probability estimates for dysphagia (4.1%) in 30,600 patients undergoing ACDF, which was presumed to be similar between the two groups. Probability estimates for the various complications other than reoperation were considered to be similar between the Allo and SC groups (Table 1).…”

“…Previous analyses comparing Allo and SC have reached mixed conclusions regarding their cost-effectiveness 7,11,12. In recent years, several large database studies comparing outcomes between the two techniques have suggested a higher revision rate with SC and may provide estimates for an improved and updated cost-utility analysis 13–15. Thus, the aim of our current investigation is to conduct a cost-analysis comparing SC versus Allo over a five-year timeframe.…”

Long-term results comparison after anterior cervical discectomy with BGS-7 spacer (NOVOMAX®-C) and allograft spacer: A prospective observational study

“…the use of an allograft spacer in ACDF has a risk of occurring various complications including infection or immune reaction due to donor tissue as well as cage-related complications including subsidence, cage migration, breakage, and collapse. ( Woo et al, 2019 ; Menon et al, 2021 ; Yang et al, 2021 ). Several bone substitutes have been developed to overcome such limitations, including bioactive ceramics, beta-tricalcium phosphate, and hydroxyapatite.…”