Do the Choice of Fusion Construct With and Without Autograft Influence the Fusion and Complication Rates in Patients Undergoing 1 or 2-Level Anterior Cervical Discectomy and Fusion Surgery? A PRISMA-Compliant Network Meta-Analysis

• Published in: Global spine journal Vol. 14; no. 2_suppl; pp. 59 - 69
• Main Authors: Muthu, Sathish, Viswanathan, Vibhu Krishnan, Rodrigues-Pinto, Ricardo, Cabrera, Juan P., Ćorluka, Stipe, Martin, Christopher T., Collins, Michael J., Agarwal, Neha, Wu, Yabin, Wang, Jeffrey C., Meisel, Hans Jörg, Buser, Zorica
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.02.2024; Sage Publications Ltd
• Subjects: Meta-analysis; Topic 4a; autograft; anterior cervical discectomy and fusion; osteobiologics; complication rates; autologous bone graft; spinal fusion
• ISSN: 2192-5682; 2192-5690
• DOI: 10.1177/21925682231154488

Study Design Network meta-analysis. Objectives To compare the fusion outcome and complications of different 1 or 2-level anterior cervical decompression and fusion (ACDF) constructs performed with and without the application of autografts. Methods We performed an independent and duplicate search in electronic databases including PubMed, Embase, Web of Science, Cochrane, and Scopus for relevant articles published between 2000 and 2020. We included comparative studies reporting fusion rate and complications with and without the use of autografts in ACDF across 5 different fusion constructs. A network meta-analysis was performed in Stata, categorized based on the type of fusion constructs utilized. Fusion constructs were ranked based on p-score approach and surface under cumulative ranking curve (SUCRA) scores. The confidence of results from the analysis was appraised with Cochrane’s CINeMA approach. Results A total of 2216 patients from 22-studies including 6 Randomized Controlled Trials (RCTs) and 16 non-RCTs were included in network analysis. The mean age of included patients was 49.3 (±3.62) years. Based on our meta-analysis, we could conclude that use of autograft in 1- or 2-level ACDF did not affect the fusion and mechanical implant-related complications. The final fusion and mechanical complication rates were also not significantly different across the different fusion constructs. The use of plated constructs was associated with a significant increase in post-ACDF dysphagia rates [OR 3.42; 95%CI (.01,2.45)], as compared to stand-alone constructs analysed. Conclusion The choice of fusion constructs and use of autografts does not significantly affect the fusion and overall complication rates following 1 or 2-level ACDF surgery.