Risk Factors of Nonfusion after Anterior Cervical Decompression and Fusion in the Early Postoperative Period: A Retrospective Study

Autor: Zihan Peng, Li Liu, Xiaqing Sheng, Hao Liu, Chen Ding, Beiyu Wang, Ying Hong, Xiaoli Pan, Yang Meng
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Orthopaedic Surgery, Vol 15, Iss 10, Pp 2574-2581 (2023)
Druh dokumentu: article
ISSN: 1757-7861
1757-7853
DOI: 10.1111/os.13835
Popis: Objective Although high fusion rates have been reported for anterior cervical decompression and fusion (ACDF) in the medium and long term, the risk of nonfusion in the early period after ACDF remains substantial. This study investigates early risk factors for cage nonfusion in patients undergoing single‐ or multi‐level ACDF. Methods This was a retrospective study. From August 2020 to December 2021, 107 patients with ACDF, including 197 segments, were enrolled, with a follow‐up of 3 months. Among the 197 segments, 155 were diagnosed with nonfusion (Nonfusion group), and 42 were diagnosed with fusion (Fusion group) in the early period after ACDF. We assessed the significance of the patient‐specific factors, radiographic indicators, serum factors, and clinical outcomes. The Wilcoxon rank sum test, t‐tests, analysis of variance, and stepwise multivariate logistic regression were used for statistical analysis. Results Univariate analysis showed that smoking, insufficient improvement in the C2‐7 Cobb angle (p = 0.024) and the functional spinal unit Cobb angle (p = 0.022) between preoperative and postoperative stages and lower serum calcium (fusion: 2.34 ± 0.12 mmol/L; nonfusion: 2.28 ± 0.17 mmol/L, p = 0.003) β‐carboxyterminal telopeptide end of type 1 collagen (β‐CTX) (fusion: 0.51 [0.38, 0.71]; nonfusion: 0.43 [0.31, 0.57], p = 0.008), and N‐terminal fragment of osteocalcin (N‐MID‐BGP) (fusion: 18.30 [12.15, 22.60]; nonfusion: 14.45 [11.65, 18.60], p = 0.023) are risk factors for nonfusion in the early period after ACDF. Stepwise logistic regression analysis revealed that poor C2‐7 Cobb angle improvement (odds ratio [OR], 1.107 [1.019–1.204], p = 0.017) and lower serum calcium (OR, 3.700 [1.138–12.032], p = 0.030) are risk factors. Conclusions Patients with successful fusion after ACDF had higher preoperative serum calcium and improved C2‐7 Cobb angle than nonfusion patients at 3 months. These findings suggest that serum calcium could be used to identify patients at risk of nonfusion following ACDF and that correcting the C2‐7 Cobb angle during surgery could potentially increase fusion in the early period after ACDF.
Databáze: Directory of Open Access Journals
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