Cages in ACDF are Associated With a Higher Nonunion Rate Than Allograft: A Stratified Comparative Analysis of 6130 Patients.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 03 2019
15 03 2019
Historique:
pubmed:
5
9
2018
medline:
25
12
2019
entrez:
5
9
2018
Statut:
ppublish
Résumé
A retrospective database review. 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). Existing literature consists primarily of single-center studies with inconsistent findings. 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. 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. The increased rate of nonunion associated with intervertebral cages may suggest the superiority of allograft over cages in ACDF. 3.
Sections du résumé
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.
Identifiants
pubmed: 30180149
doi: 10.1097/BRS.0000000000002854
pii: 00007632-201903150-00006
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
384-388Références
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