3:53 Anterior discectomy with fusion with allograft and plating

Abstract Purpose of study: 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 three- and four-level fusions. We report our experience with 134 patients (272 levels). Methods used: A total of 134 patients underwent anterior cervical discectomy 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) by means of a modified Smith-Robinson technique. All surgeries were performed by the primary senior author (RFD). Key elements of the surgical technique emphasize 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 years. Comorbidities included 16 smokers, 4 diabetics, 6 previous surgeries, and 1 trauma. Patients wore an external orthosis for 6 weeks. of findings: There was one reoperation for junctional disease. Six patients developed junctional disease. Eight patients had residual radiographic lucent lines and/or hardware failure at most recent follow-up for a fusion rate of 94% (126 of 134) of patients and 97.8% (266 of 272 of levels). There were six instances of hardware failure and/or pseudarthrosis, four of which occurred in the three- and four-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). Relationship between findings and existing knowledge: We believe this series to be the largest reported ACDF series with 2-year follow-up that includes three and four levels. Overall significance of findings: Extremely high fusion rates with only one reoperation were recorded in this series, including three- and four-level constructs, with an acceptable complication rate. We believe that outstanding results are obtainable with allograft and plate, even at three or four levels, when the principles of precise fit and fill of the interspace with a contoured graft and fixation, which facilitate compression are followed. We believe this series to be the largest reported ACDF series with 2-year follow-up that includes three and four levels. Disclosures: No disclosures. Conflict of interest: No conflicts.