Abstract
Study Design: Retrospective cohort study. Objectives: To identify preoperative radiographic parameters that can guide optimal allograft height selection for anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Allograft height selection for ACDF depends on intraoperative assessment supported by trials; however, there is currently no radiographic reference parameter that could aid in allograft height selection for improved outcomes. Methods: A total of 148 patients who underwent ACDF using allografts and were followed up for more than 1 year were retrospectively reviewed. Fusion rates, subsidence, segmental lordosis, and foraminal height were assessed. Segments were divided into 2 groups according to whether the inserted allograft height was within 1 mm from the following 3 reference radiographic parameters: (1) uncinate process height, (2) adjacent disc height, and (3) preoperative disc height +2 mm. Results: This study included 101 patients with 163 segments. Segments with an allograft-uncinate height difference of ≤1 mm had a significantly higher fusion rate at 1-year follow-up compared with segments with allograft-uncinate height difference of >1 mm [85/107 (79.4%) vs. 35/56 (62.5%); P=0.025]. Subsidence, segmental lordosis, and foraminal height did not significantly differ between the groups when segments were divided according to uncinate height. Multivariate logistic regression analysis demonstrated that allograft-uncinate height difference of ≤1 mm and allograft failure were factors associated with fusion. Conclusions: The uncinate process height can guide optimal allograft height selection for ACDF. Using an allograft with an allograft-uncinate height difference of ≤1 mm resulted in a higher fusion rate. Therefore, the uncinate process height should be checked preoperatively and used in conjunction with intraoperative assessment when selecting allograft height.
Original language | English |
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Pages (from-to) | 75-82 |
Number of pages | 8 |
Journal | Clinical Spine Surgery |
Volume | 36 |
Issue number | 3 |
DOIs | |
State | Published - 1 Apr 2023 |
Keywords
- allograft
- allograft size
- anterior cervical discectomy and fusion
- indirect decompression
- pseudarthrosis
- subsidence
- uncinate height