Longer Screws Decrease the Risk of Radiographic Pseudarthrosis Following Elective Anterior Cervical Discectomy and Fusion

Author:

Chanbour Hani1ORCID,Bendfeldt Gabriel A.2,Johnson Graham W.3ORCID,Peterson Keyan1,Ahluwalia Ranbir1,Younus Iyan1,Longo Michael1,Abtahi Amir M.14,Stephens Byron F.14ORCID,Zuckerman Scott L.14ORCID

Affiliation:

1. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

2. School of Medicine, Vanderbilt University, Nashville, TN, USA

3. Biomedical Engineering, Vanderbilt University, Nashville, TN, USA

4. Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

Abstract

Study Design Retrospective cohort study. Objectives In patients undergoing elective anterior cervical discectomy and fusion (ACDF), we sought to determine the impact of screw length on: (1) radiographic pseudarthrosis, (2) pseudarthrosis requiring reoperation, and (3) patient-reported outcome measures (PROMs). Methods A single-institution, retrospective cohort study was undertaken from 2010-21. The primary independent variables were: screw length (mm), screw length divided by the anterior-posterior vertebral body diameter (VB%), and the presence of any screw with VB% < 75% vs all screws with VB% ≥ 75%. Multivariable logistic regression controlled for age, BMI, gender, smoking, American Society of Anesthesiology grade, number of levels fused, and whether a corpectomy was performed. Results Of 406 patients undergoing ACDF, levels fused were: 1-level (39.4%), 2-level (42.9%), 3-level (16.7%), and 4-level (1.0%). Mean screw length was 14.3 ± 2.3 mm, and mean VB% was 74.4 ± 11.2. A total of 293 (72.1%) had at least one screw with VB% < 75%, 113 (27.8%) had all screws with VB% ≥ 75%, and 141 (34.7%) patients had radiographic pseudarthrosis at 1-year. Patients who had any screw with VB% < 75% had a higher rate of radiographic pseudarthrosis compared to those had all screws with VB% ≥ 75% (39.6% vs 22.1%, P < .001). Multivariable logistic regression revealed that a higher VB% (OR = .97, 95%CI = .95-.99, P = .035) and having all screws with VB% ≥ 75% (OR = .51, 95%CI = .27-.95, P = .037) significantly decreased the odds of pseudarthrosis at 1-year, with no difference in reoperation or PROMs (all P > .05). Conclusion Longer screws taking up ≥75% of the vertebral body protected against radiographic pseudarthrosis at 1-year. Maximizing screw length in ACDF is an easily modifiable factor directly under the surgeon’s control that may mitigate the risk of pseudarthrosis.

Funder

National Football League

Nuvasive and Stryker Spine

Stryker Spine

Publisher

SAGE Publications

Subject

Neurology (clinical),Orthopedics and Sports Medicine,Surgery

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