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Does Graft Position Affect Subsidence After Anterior Cervical Discectomy and Fusion?

 Hyun-Jun Jang  ;  Dong-Kyu Chin  ;  Kyung-Hyun Kim  ;  Jeong-Yoon Park 
 GLOBAL SPINE JOURNAL, Vol.12(4) : 668-676, 2022-05 
Journal Title
Issue Date
ACDF ; allograft ; anterior cervical discectomy and fusion ; cervical ; subsidence
Study design: Retrospective cohort study.

Objective: Implant subsidence is an important prognostic factor after anterior cervical discectomy and fusion (ACDF). Our purpose in this study was to investigate whether graft position affects subsidence after ACDF and to determine if there is a difference in clinical results based on allograft subsidence and position.

Methods: We reviewed 92 patients who underwent single-level ACDF with allograft and plate between January 2012 and October 2018. Treatment levels were divided based on allograft position within 2 mm of the posterior margin of the augmented plate (Anterior group) or at greater than 2 mm (Center group). Subsidence was defined as segmental vertebral body height decrease of 2 mm or more at 1 year compared to 1 week after surgery.

Results: Overall subsidence prevalence was 15 (16%) cases. Subsidence was 11% in the Anterior group (8/73) and 39% in the Center group (7/19; P = .012). The subsidence group showed smaller graft footprint size (graft/endplate ratio) compared with the nonsubsidence group, and pseudarthrosis occurred frequently in the subsidence. There was no significant difference in clinical results according to graft position. These findings indicate that anterior graft position reduces risk of subsidence (95% confidence interval = 0.085-0.949).

Conclusion: To minimize risk of subsidence, the graft should be positioned on the anterior position of the surgical-level endplate. In addition, using a graft appropriate for endplate size will further reduce subsidence.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyung Hyun(김경현)
Park, Jeong Yoon(박정윤) ORCID logo https://orcid.org/0000-0002-3728-7784
Jang, Hyun Jun(장현준)
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
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