Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.

Bergin, Stephen M; Wang, Timothy Y; Park, Christine; Rajkumar, Shashank; Goodwin, C Rory; Karikari, Isaac O; Abd-El-Barr, Muhammad M; Shaffrey, Christopher I; Yarbrough, Chester K; Than, Khoi D

Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.

dc.contributor.author	Bergin, Stephen M
dc.contributor.author	Wang, Timothy Y
dc.contributor.author	Park, Christine
dc.contributor.author	Rajkumar, Shashank
dc.contributor.author	Goodwin, C Rory
dc.contributor.author	Karikari, Isaac O
dc.contributor.author	Abd-El-Barr, Muhammad M
dc.contributor.author	Shaffrey, Christopher I
dc.contributor.author	Yarbrough, Chester K
dc.contributor.author	Than, Khoi D
dc.date.accessioned	2023-06-19T18:19:50Z
dc.date.available	2023-06-19T18:19:50Z
dc.date.issued	2021-06
dc.date.updated	2023-06-19T18:19:49Z
dc.description.abstract	Objective The use of osteobiologics, engineered materials designed to promote bone healing by enhancing bone growth, is becoming increasingly common for spinal fusion procedures, but the efficacy of some of these products is unclear. The authors performed a retrospective, multi-institutional study to investigate the clinical and radiographic characteristics of patients undergoing single-level anterior cervical discectomy with fusion performed using the osteobiologic agent Osteocel, an allograft mesenchymal stem cell matrix. Methods The medical records across 3 medical centers and 12 spine surgeons were retrospectively queried for patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with the use of Osteocel. Pseudarthrosis was determined based on CT or radiographic imaging of the cervical spine. Patients were determined to have radiographic pseudarthrosis if they met any of the following criteria: 1) lack of bridging bone on CT obtained > 300 days postoperatively, 2) evidence of instrumentation failure, or 3) motion across the index level as seen on flexion-extension cervical spine radiographs. Univariate and multivariate analyses were then performed to identify independent preoperative or perioperative predictors of pseudarthrosis in this population. Results A total of 326 patients met the inclusion criteria; 43 (13.2%) patients met criteria for pseudarthrosis, of whom 15 (34.9%) underwent revision surgery. There were no significant differences between patients with and those without pseudarthrosis, respectively, for patient age (54.1 vs 53.8 years), sex (34.9% vs 47.4% male), race, prior cervical spine surgery (37.2% vs 33.6%), tobacco abuse (16.3% vs 14.5%), chronic kidney disease (2.3% vs 2.8%), and diabetes (18.6% vs 14.5%) (p > 0.05). Presence of osteopenia or osteoporosis (16.3% vs 3.5%) was associated with pseudarthrosis (p < 0.001). Implant type was also significantly associated with pseudarthrosis, with a 16.4% rate of pseudarthrosis for patients with polyetherethereketone (PEEK) implants versus 8.4% for patients with allograft implants (p = 0.04). Average lengths of follow-up were 27.6 and 23.8 months for patients with and those without pseudarthrosis, respectively. Multivariate analysis demonstrated osteopenia or osteoporosis (OR 4.97, 95% CI 1.51-16.4, p < 0.01) and usage of PEEK implant (OR 2.24, 95% CI 1.04-4.83, p = 0.04) as independent predictors of pseudarthrosis. Conclusions In patients who underwent single-level ACDF, rates of pseudarthrosis associated with the use of the osteobiologic agent Osteocel are higher than the literature-reported rates associated with the use of alternative osteobiologics. This is especially true when Osteocel is combined with a PEEK implant.
dc.identifier	2021.3.FOCUS2166
dc.identifier.issn	1092-0684
dc.identifier.issn	1092-0684
dc.identifier.uri	https://hdl.handle.net/10161/28097
dc.language	eng
dc.publisher	Journal of Neurosurgery Publishing Group (JNSPG)
dc.relation.ispartof	Neurosurgical focus
dc.relation.isversionof	10.3171/2021.3.focus2166
dc.subject	Cervical Vertebrae
dc.subject	Bone Matrix
dc.subject	Humans
dc.subject	Pseudarthrosis
dc.subject	Treatment Outcome
dc.subject	Spinal Fusion
dc.subject	Diskectomy
dc.subject	Retrospective Studies
dc.subject	Middle Aged
dc.subject	Female
dc.subject	Male
dc.subject	Allografts
dc.title	Pseudarthrosis rate following anterior cervical discectomy with fusion using an allograft cellular bone matrix: a multi-institutional analysis.
dc.type	Journal article
duke.contributor.orcid	Goodwin, C Rory\|0000-0002-6540-2751
duke.contributor.orcid	Abd-El-Barr, Muhammad M\|0000-0001-7151-2861
duke.contributor.orcid	Shaffrey, Christopher I\|0000-0001-9760-8386
duke.contributor.orcid	Yarbrough, Chester K\|0000-0003-0546-6435
pubs.begin-page	E6
pubs.issue	6
pubs.organisational-group	Duke
pubs.organisational-group	School of Medicine
pubs.organisational-group	Faculty
pubs.organisational-group	Clinical Science Departments
pubs.organisational-group	Institutes and Centers
pubs.organisational-group	Orthopaedic Surgery
pubs.organisational-group	Radiation Oncology
pubs.organisational-group	Duke Cancer Institute
pubs.organisational-group	Neurosurgery
pubs.publication-status	Published
pubs.volume	50