Urinary N-Telopeptide Can Predict Pseudarthrosis After Anterior Cervical Decompression and Fusion
Autor: | Pooja Prabhakar, Patrick Hill, Virginie Lafage, Todd J. Albert, Philip Saville, Jingyan Yang, Brandon B. Carlson, Renaud Lafage, Han Jo Kim, Emily M. Stein, Eric Feuchtbaum, Rachel S. Bronheim, Michael E. Steinhaus |
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Rok vydání: | 2019 |
Předmět: |
Adult
Male medicine.medical_specialty Decompression Urinary system Collagen Type I Young Adult 03 medical and health sciences 0302 clinical medicine N-terminal telopeptide Predictive Value of Tests medicine Humans Orthopedics and Sports Medicine Prospective Studies Prospective cohort study Aged 030222 orthopedics Neck pain Neck Pain business.industry Odds ratio Middle Aged Decompression Surgical medicine.disease Surgery Pseudarthrosis Spinal Fusion Treatment Outcome Predictive value of tests Cervical Vertebrae Female Spinal Diseases Neurology (clinical) medicine.symptom Peptides business Biomarkers 030217 neurology & neurosurgery |
Zdroj: | Spine. 44:770-776 |
ISSN: | 1528-1159 0362-2436 |
Popis: | Study design Prospective cohort study. Objective To examine preoperative urinary cross-linked n-telopeptide (uNTx) and assess for association with fusion rates in patients undergoing single and multi-level anterior cervical decompression and fusion (ACDF). Summary of background data Although high rates of fusion have been reported for ACDF, the risk of pseudarthrosis remains substantial. An established marker of bone turnover, uNTx may prove useful as a predictor of fusion. Methods Patients undergoing primary ACDF with allograft/plating technique from 2015 to 2017 by a single surgeon were consecutively enrolled and preoperative uNTx was collected. Patients undergoing revision, with creatinine >1.2, and with improperly-collected uNTx were excluded. Demographics, laboratory values, and fusion status were assessed at 6 months, 1 year, and 2 years postoperatively. Results Of the 97 patients enrolled, 69 met inclusion criteria. Of included cases, 41%, 33%, 18%, and 8% underwent 1-, 2-, 3-, and 4-level ACDF, respectively. Overall, fusion rates were 37.3%, 70.9%, and 95.3% at 6 months, 1 year, and 2 years, respectively. uNTx was higher in the fusion group (31.1 vs. 22.2, P = 0.001) at 6 months and 1 year (30.0 vs. 21.0, P = 0.006), with no difference at 2 years. No differences were identified in the proportion of smokers, immunomodulatory agents, corpectomies, or fusion levels between groups. Multivariate regression analysis demonstrated that uNTx is an independent predictor of fusion (odds ratio, OR, 1.124, P = 0.003). Both groups experienced improvements in NDI and VAS neck pain at 6 months with no significant differences noted between groups. Of 16 patients with pseudarthrosis at 1 year, 2 underwent posterior cervical fusion for symptoms. Conclusion Preoperative uNTx was greater in patients with successful ACDF fusion compared with patients with pseudarthrosis at 6 months and 1 year. A negative correlation was found between preoperative uNTx and motion on dynamic imaging. These results suggest that uNTx could serve to identify patients at risk for pseudarthrosis after ACDF. Level of evidence 3. |
Databáze: | OpenAIRE |
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