scholarly journals Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

2020 ◽  
Vol 32 (4) ◽  
pp. 562-569
Author(s):  
Minghao Wang ◽  
Dean Chou ◽  
Chih-Chang Chang ◽  
Ankit Hirpara ◽  
Yilin Liu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Anterior Plate ◽  
Cervical Discectomy ◽  
Posterior Surgery ◽  
Structural Allograft ◽  
Significant Difference ◽  
Surgery Rates

OBJECTIVEBoth structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.METHODSThe authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.RESULTSA total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.CONCLUSIONSIn 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

scholarly journals PEEK interbody devices for multilevel anterior cervical discectomy and fusion: association with more than 6-fold higher rates of pseudarthrosis compared to structural allograft

2020 ◽  
Vol 32 (5) ◽  
pp. 696-702 ◽  
Author(s):  
Zoe E. Teton ◽  
Barry Cheaney ◽  
James T. Obayashi ◽  
Khoi D. Than
Keyword(s):  
Logistic Regression ◽  
Data Analysis ◽  
Tobacco Use ◽  
Revision Surgery ◽  
Smoking Status ◽  
Anterior Cervical Discectomy ◽  
Radiographic Evidence ◽  
Cervical Discectomy ◽  
Structural Allograft

OBJECTIVECommon interbody graft options for anterior cervical discectomy and fusion (ACDF) include allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucent properties and a modulus of elasticity similar to that of bone. PEEK devices also result in higher billing costs than allograft, which may drive selection. A previous study found a 5-fold higher rate of pseudarthrosis with the use of PEEK devices compared with structural allograft in single-level ACDF. Here the authors report on the occurrence of pseudarthrosis with PEEK devices versus structural allograft in patients who underwent multilevel ACDF.METHODSThe authors retrospectively reviewed 81 consecutive patients who underwent a multilevel ACDF and had radiographic follow-up for at least 1 year. Data were collected on age, sex, BMI, tobacco use, pseudarthrosis, and rate of reoperation for pseudarthrosis. Logistic regression was used for data analysis.RESULTSOf 81 patients, 35 had PEEK implants and 46 had structural allograft. There were no significant differences between age, sex, smoking status, or BMI in the 2 groups. There were 26/35 (74%) patients with PEEK implants who demonstrated radiographic evidence of pseudarthrosis, compared with 5/46 (11%) patients with structural allograft (p < 0.001, OR 22.2). Five patients (14%) with PEEK implants required reoperation for pseudarthrosis, compared with 0 patients with allograft (p = 0.013).CONCLUSIONSThis study reinforces previous findings on 1-level ACDF outcomes and suggests that the use of PEEK in multilevel ACDF results in statistically significantly higher rates of radiographic pseudarthrosis and need for revision surgery than allograft. Surgeons should consider these findings when determining graft options, and reimbursement policies should reflect these discrepancies.

scholarly journals Fivefold higher rate of pseudarthrosis with polyetheretherketone interbody device than with structural allograft used for 1-level anterior cervical discectomy and fusion

2019 ◽  
Vol 30 (1) ◽  
pp. 46-51 ◽  
Author(s):  
Katie L. Krause ◽  
James T. Obayashi ◽  
Kelly J. Bridges ◽  
Ahmed M. Raslan ◽  
Khoi D. Than
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Tobacco Use ◽  
Revision Surgery ◽  
Bone Growth ◽  
Anterior Cervical Discectomy ◽  
Disc Space ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Significant Difference

OBJECTIVECommon interbody graft options for anterior cervical discectomy and fusion (ACDF) include structural allograft and polyetheretherketone (PEEK). PEEK has gained popularity due to its radiolucency and its elastic modulus, which is similar to that of bone. The authors sought to compare the rates of pseudarthrosis, a lack of solid bone growth across the disc space, and the need for revision surgery with the use of grafts made of allogenic bone versus PEEK.METHODSThe authors retrospectively reviewed 127 cases in which patients had undergone a 1-level ACDF followed by at least 1 year of radiographic follow-up. Data on age, sex, body mass index, tobacco use, pseudarthrosis, and the reoperation rate for pseudarthrosis were collected. These data were analyzed by performing a Pearson’s chi-square test.RESULTSOf 127 patients, 56 had received PEEK implants and 71 had received allografts. Forty-six of the PEEK implants (82%) were stand-alone devices. There were no significant differences between the 2 treatment groups with respect to patient age, sex, or body mass index. Twenty-nine (52%) of 56 patients with PEEK implants demonstrated radiographic evidence of pseudarthrosis, compared to 7 (10%) of 71 patients with structural allografts (p < 0.001, OR 9.82; 95% CI 3.836–25.139). Seven patients with PEEK implants required reoperation for pseudarthrosis, compared to 1 patient with an allograft (p = 0.01, OR 10.00; 95% CI 1.192–83.884). There was no significant difference in tobacco use between the PEEK and allograft groups (p = 0.586).CONCLUSIONSThe results of this study demonstrate that the use of PEEK devices in 1-level ACDF is associated with a significantly higher rate of radiographically demonstrated pseudarthrosis and need for revision surgery compared with the use of allografts. Surgeons should be aware of this when deciding on interbody graft options, and reimbursement policies should reflect these discrepancies.

scholarly journals A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

2019 ◽  
Author(s):  
ING HOW MOO ◽  
Carmen Jia Wen Kam ◽  
Maksim Wen Sheng Lai ◽  
William Yeo ◽  
Reuben Chee Cheong Soh
Keyword(s):  
Neck Pain ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Peek Cage ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

scholarly journals A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

2019 ◽  
Author(s):  
ING HOW MOO ◽  
Carmen Jia Wen Kam ◽  
Maksim Wen Sheng Lai ◽  
William Yeo ◽  
Reuben Chee Cheong Soh
Keyword(s):  
Neck Pain ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Peek Cage ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Cage Subsidence

Abstract Background: The effectiveness of graft type in two-level anterior cervical discectomy and fusion (ACDF) with plate fixation remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level anterior cervical decompression and fusion (ACDF) with plate fixation using either a structural allograft or a polyetheretherketone (PEEK) cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

scholarly journals A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

2020 ◽  
Author(s):  
ING HOW MOO ◽  
Carmen Jia Wen Kam ◽  
Maksim Wen Sheng Lai ◽  
William Yeo ◽  
Reuben Chee Cheong Soh
Keyword(s):  
Neck Pain ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Peek Cage ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

scholarly journals A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

2020 ◽  
Author(s):  
ING HOW MOO ◽  
Carmen Jia Wen Kam ◽  
Maksim Wen Sheng Lai ◽  
William Yeo ◽  
Reuben Chee Cheong Soh
Keyword(s):  
Neck Pain ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Peek Cage ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

scholarly journals A Comparison of Contiguous Two-level Anterior Cervical Discectomy and Fusion using a Structural Allograft versus a Polyetheretherketone (PEEK) Cage: The Results of a Three-Year Follow-up

2020 ◽  
Author(s):  
ING HOW MOO ◽  
Carmen Jia Wen Kam ◽  
Maksim Wen Sheng Lai ◽  
William Yeo ◽  
Reuben Chee Cheong Soh
Keyword(s):  
Neck Pain ◽  
Clinical Outcomes ◽  
Plate Fixation ◽  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Peek Cage ◽  
Cervical Discectomy ◽  
Structural Allograft ◽  
Cage Subsidence

Abstract Background: Allografts and polyetheretherketone (PEEK) cages are the two most commonly used material in anterior cervical discectomy and fusion (ACDF). However, their effectiveness in in two-level ACDF remains controversial. The primary aim of this retrospective study is to compare the clinical and radiological outcomes of two-level ACDF with plate fixation using either a structural allograft or a PEEK cage. Methods: From 2010 to 2015, 88 consecutive patients underwent a two-level ACDF of which 53 used an allograft and 35 patients with a PEEK cage. All PEEK cages were filled with local autografts. All clinical outcomes were prospectively collected preoperatively, at six months and at two years after surgery. Clinical efficacy was evaluated using visual analogue scale for neck pain and limb pain, the Neck Pain and Disability Score, Neck Disability Index, Neurogenic Symptom Score, and the Japan Orthopedic Association score. Radiological outcomes were assessed preoperatively, immediately after surgery, and at the final follow-up. Results: A preoperative comparison revealed no difference between the two patient groups in terms of age, gender, body mass index, smoking status, preoperative symptoms, operated levels, and follow-up (mean= 42.8 months). No difference in improvements in the clinical outcome between the two groups was observed. Both groups showed significant improvement in mean disc height, segmental height, and segmental lordosis postoperatively. The fusion rates for PEEK cage was 100% at both levels while the fusion rates for allograft group was 98.1% at cephalad level and 94.2% at caudad level (p>0.05). Subsidence at the cephalad level occurred in 22.9% (8/35) segments in the PEEK group and 7.7% (4/52) segments in the allograft group (p=0.057). At the caudal level, a higher cage subsidence was noted in the PEEK group compared to the allograft group [37.1% (13/35) versus 15.4% (8/52)] (p=0.02). Overall, subsidence was noted in 30% (21/70) of the PEEK group and in 11% (12/104) of the allograft group (p<0.05). Conclusion: The use of PEEK cages resulted in a higher rate of subsidence in two-level ACDF as compared to allograft. Two-level ACDF using either allografts or PEEK cages resulted in similar clinical outcomes, radiological improvements in alignment and fusion rates.

scholarly journals Revision Rates After Surgical Treatment for Femoral Neck Fractures: Results of 2-Year Follow-up

Medicina ◽  
2013 ◽  
Vol 49 (3) ◽  
pp. 22
Author(s):  
Jaunius Kurtinaitis ◽  
Narūnas Porvaneckas ◽  
Giedrius Kvederas ◽  
Tomas Butėnas ◽  
Valentinas Uvarovas
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Femoral Neck Fractures ◽  
Total Hip ◽  
Significant Difference ◽  
Surgery Rates

Background and Objective. Intracapsular fractures of the femoral neck account for a major share of fractures in the elderly. Open reduction and internal fixation has been shown to have a higher rate of revision surgery than arthroplasty. The aim of this study was to assess and compare the rates of revision surgery performed after internal fixation and primary total hip arthroplasty. Material and Methods. Between 2004 and 2006, 681 intracapsular femoral neck fractures in 679 consecutive patients were treated with internal fixation or total hip arthroplasty at our institution. Revision surgery rates were evaluated at 1-, 3-, 6-, 12-, and 24-month follow-up. Results. There was no significant difference in the ratio of internal fixation to total hip arthroplasty during 2004–2006 (P=0.31). The mean rate of total hip arthroplasty was 19.1% with a lower rate being among patients younger than 60 years. Revision surgery rates at the 2-year followup were higher in the internal fixation group compared with total hip arthroplasty group (28.9% vs. 7.0%, P<0.001). Patients who underwent internal fixation were at a 4-fold greater risk of having revision surgery at the 2-year follow-up than those who underwent total hip arthroplasty (odds ratio, 4.11; 95% CI, 1.95–8.65; P<0.001). Age was a significant risk factor for revision surgery after total hip arthroplasty (hazard ratio, 0.93; 95% CI, 0.87–0.98; P=0.02), but not significant after the internal fixation (P=0.86). Conclusions. Higher revision surgery rates after internal fixation favors arthroplasty as a primary choice of treatment for the femoral neck fractures.

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

2013 ◽  
Vol 19 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Myles Luszczyk ◽  
Justin S. Smith ◽  
Jeffrey S. Fischgrund ◽  
Steven C. Ludwig ◽  
Rick C. Sasso ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Fusion Rate ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Significant Difference ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

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