Alignment more important than graft type for anterior cervical fusion success

OrthoSupersite
By Lee Beadling
November 2009

SAN FRANCISCO — While the use of either lordotic or parallel-shaped allografts had no effect on outcomes of anterior cervical decompression fusion, the accuracy of the segmental sagittal alignment did relate to clinical improvement, according to a prospective, randomized clinical trial.

“It doesn’t matter if you use parallel or lordotic grafts in anterior cervical decompression fusion, it matters that you maintain or improve the segmental sagittal alignment in those patients,” Alan Villavicencio, MD, said at the 24th Annual Meeting of the North American Spine Society.

According to the study abstract, 122 patients were enrolled in the study and were randomized to receive a lordotic allograft (57 patients) or a parallel allograft (65 patients). Average patient age was 49.9 years and mean follow-up was 37.5 months.

Pre- and postoperative assessments were performed radiographically and clinically using a Visual Analog Scale, SF-36 and the Neck Disability Index (NDI), Villavicencio said. Sagittal alignment was measured using a posterior tangent method on cervical lateral neutral radiographs. Two sagittal alignment parameters were measured.

“There were also no statistically significant differences in the clinical outcomes between the lordotic and parallel graft groups, VAS, SF-36 and NDI,” he said.

The mean postoperative cervical alignment was 18.6° in the lordotic group and 18.2° in the parallel group.

“In 68 patients who had either maintenance or improvement of sagittal alignment compared to 17 patients who had a loss of sagittal alignment with a change toward lordosis, the patients with maintained or improved alignment, had statistically significant improvement in their SF-36 and the NDI scores,” he said.

Reference:

Villavicencio A, Babuska J, Nelson E, et al. Correlation of clinical outcomes and cervical sagittal alignment: A prospective randomized clinical study. Paper #4. Presented at the 24th Annual Meeting of the North American Spine Society. Nov. 10-14, 2009. San Francisco.