Comparing Allografts to Autografts for Maintenance of Cervical Sagittal Parameters and Clinical Outcomes Following Anterior Cervical Discectomy and Fusion With Anterior Cervical Plating

Steven Thomas Heidt; Philip King-Hung Louie; Jannat M Khan; Bryce A Basques; Brandon Hirsch; Arya Varthi; Justin C Paul; Edward J Goldberg; Howard S An

doi:10.14245/ns.1836202.101

Comparing Allografts to Autografts for Maintenance of Cervical Sagittal Parameters and Clinical Outcomes Following Anterior Cervical Discectomy and Fusion With Anterior Cervical Plating

Neurospine. 2019 Sep;16(3):618-625. doi: 10.14245/ns.1836202.101. Epub 2019 Feb 23.

Authors

Steven Thomas Heidt¹, Philip King-Hung Louie¹, Jannat M Khan¹, Bryce A Basques¹, Brandon Hirsch¹, Arya Varthi², Justin C Paul³, Edward J Goldberg¹, Howard S An¹

Affiliations

¹ Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
² Yale University School of Medicine, Chicago, IL, USA.
³ Danbury Orthopaedics, Danbury, CT, USA.

Abstract

Objective: Current literature has not shown if using either allograft or autograft differentially affects postoperative cervical sagittal parameters. The goal of this study was to compare sagittal alignment and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) with allograft versus autograft.

Methods: A retrospective cohort analysis of patients who underwent single-level ACDF was conducted. Preoperative, immediate postoperative, and final follow-up radiographic assessments were conducted and included: change in C2-7 lordosis, T1 slope, levels fused, sagittal vertical axis (SVA), fusion mass lordosis, and proximal and distal adjacent segment degeneration (ASD). Patient-reported outcomes were obtained using the Neck Disability Index and visual analogue scale scores for neck and arm.

Results: A total of 404 patients were assessed; 353 using allograft and 51 using autograft. No significant differences existed in demographics. Cervical lordosis improved in both groups without significant changes in SVA. Autograft group had a significantly greater amount of lordosis at the proximal segment on immediate postoperative radiographs and less overall cervical lordosis at final follow-up. Sagittal parameters were similar at each time point without significant changes between the 3-time points. No significant differences existed in radiographic ASD or reoperation rates. Fusion rates exceeded 96% in both groups. No significant differences existed between preoperative, postoperative, or change in patient-reported outcomes between the 2 groups.

Conclusion: Sagittal alignment is maintained following ACDF when using either allograft or autograft. Radiographic evidence of ASD is present in both groups; however, this was not considered clinically significant, given low rates of pseudarthrosis or reoperation. No significant differences exist between groups in terms of patient-reported outcomes.

Keywords: Allografts; Anterior cervical discectomy and fusion; Autografts; Clinical outcomes; Sagittal parameters.