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ACDF with autograft, without plating led to higher reoperation rates
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DALLAS — There was a significantly greater incidence of adjacent segment disease in patients that underwent autografting without plating during anterior cervical decompression and fusion (ACDF) compared to those who had allografts with plating at one or two cervical levels, according to research presented at the North American Spine Society Annual Meeting, here.
“Allograft with plating with one or two levels required approximately half the additional anterior cervical decompressions and fusions,” Vijay Agarwal, MD, who presented the study, said. “Annual incidences nearly doubled for autografts without plating.”
Agarwal and colleagues retrospectively studied 611 consecutive patients treated with 627 ACDF procedures between 1996 and 2006, some of whom were followed up until 2010. The mean follow-up was 13 years.
Investigators quantified the difference in adjacent segment disease prevalence, the number of segments at risk, and the mean annual incidence of adjacent segment disease for patients in three groups — those with autograft without plating, with allograft and 1-level plating and with allograft and 2-level plating. They also calculated the patients’ Kaplan-Meier survivorship.
The overall prevalence of adjacent segment disease the investigators found was 14.5% or 89 cases at 13 years follow-up. The mean adjacent segment disease incidence was 1.6% for autograft without plating, 0.74% for 1-level allografting with plating and 0.68% for 2-level allografting with plating.
Some 22.3% of patients with autograft without plating required additional surgery, according to the results.
Agarwal and colleagues found the cumulative survivorship for autograft without plating was 73.5%, but it was 88.4% for one-level allograft with plating.
“C5-6 levels were most at risk involving the superior and inferior segments, comparably,” Agarwal said.
Reference:
Agarwal V. Paper #130. Presented at: North American Spine Society Annual Meeting. Oct. 24-27, 2012; Dallas.
Disclosure: Agarwal has no relevant financial disclosures.
