Fusion Rates For ACDF
Below is a study showing fusion rates in a published study:
ACDF With Allograft & Anterior Plating: A Report on 134 Patients/272 levels with 2 yr follow up
David F Antezana, MD Baltimore MD
Randy F Davis, MD Glen Burnie MD (e - Medtronic)
Arthur W Poetscher, MD Baltimore MD
John Yingling, MD Baltimore MD
John Awad, MD Baltimore MD
Michael Schlosser, MD Baltimore MD
Donlin M Long, MD Baltimore MD
INTRODUCTION: Although anterior cervical discectomy and fusion is a well established technique for arthrodesis of the cervical spine, there are limited data on the use of allograft with plate in a large series with minimum 2 year follow-up. There are even fewer such studies that incorporate 3 and 4 level fusions. We report our experience with 134 patients (272 levels).
METHODS: One hundred thirty-four patients underwent anterior cervical discetomy and fusion (ACDF) with plate and allograft (56-one level, 31-two levels, 30-three levels, 16-four levels; 272 total levels: 37 C3-4, 74 C4-5, 94 C5-6, 65 C6-7, 1 C7-T1) via a modified Smith-Robinson technique. All surgeries were performed by the primary senior author (RFD). Key elements of the surgical technique emphasis precise fit and fill of the interspace in conjunction with construct compression. Radiographic fusion was determined with plain X-rays at predetermined intervals. Fusion was defined as no lucent line and no hardware failure. Hardware failure was defined as any screw loosening or shifting of the plate. Average follow-up is 37.1 months. Minimum follow up is 24 months. Average age is 50. Co-morbidities included 16 smokers, 4 diabetics, 6 previous surgeries, and 1 trauma. Patients wore an external orthosis for 6 weeks.
RESULTS: There was 1 reoperation for junctional disease. Six patient developed junctional disease. Eight patients had residual radiographic lucent lines and/or hardware failure at most recent followup for a fusion rate of 94% (126/134) of patients and 97.8% (266/272 of levels). There were 6 instances of hardware failure and/or pseudoarthrosis, 4 of which occurred in the 3 and 4 level group. Complications occurred in 12 patients (8.9%), and included dysphagia (4), vocal cord paralysis (1), fibrositis (1), respiratory distress (1), wound infection (1).
CONCLUSION/DISCUSSION: Extremely high fusion rates with only one re-operation were recorded in this series, including 3 and 4 level constructs, with an acceptable complication rate. We believe that outstanding results are obtainable with allograft and plate, even at 3 or 4 levels, when the principles of precise fit and fill of the interspace with a contoured graft and fixation which facilitates compression. We believe this series to be the largest reported ACDF series with 2-year follow-up that includes 3 and 4 levels.
Last edited by dennisgb; 10-20-2004 at 02:45 PM.