Synthetic Interbody Devices and Traditional Bone Graft are Associated With a Similar Rate of Surgical Complications after 1-2 level ACDFs

Abstract

Study Design: Retrospective cohort. Objective: To compare the rates of all-cause surgical complications of synthetic interbody devices versus allograft or autograft in patients undergoing 1-2 levels anterior cervical discectomy and fusion (ACDF) procedures. Summary of Background Data: Cervical degenerative disorders affects up to 60% of older adults in the US. Both traditional allograft or autograft and synthetic interbody devices (PEEK or titanium) are used for decompression and arthrodesis, with an increasing utilization of the latter. However, the differences in their postsurgical complication profiles are not well-characterized. Methods: Patients who underwent 1-2 level ACDF for cervical radiculopathy or myelopathy between 2010-2022 were identified using the PearlDiver Mariner all-claims insurance database. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed based on factors that were significant predictors of all-cause surgical complications in a linear regression model. The primary outcome measure was development of all-cause surgical complications following 1-2 levels ACDF. The secondary outcome was all-cause medical complications. Results: 1:1 exact matching resulted in two equal groups of 11,430 patients who received treatment with synthetic interbody devices or allograft/autograft. No statistically significant difference in all-cause surgical complications were found between the synthetic cohort and the allograft or autograft cohort following 1-2 levels ACDFs (RR 0.86, 95% CI 0.730-1.014, P = 0.079). No significant differences were observed regarding any specific surgical complications except for pseudoarthrosis (RR 0.73, 0.554-0.974, P = 0.037), which was higher in the allograft/autograft cohort. Conclusion: After 1:1 exact matching to control for confounding variables, the findings of this study suggest that all-cause surgical complications are similar in patients undergoing ACDFs with synthetic interbody devices or allograft/autographs. However, the rate of pseudarthrosis appears to be higher in patients with allograft/autographs. Future prospective studies are needed to corroborate these findings.