Early radiographic outcomes after anterior cervical discectomy and fusion with anatomic versus lordotic cages

Nadeem N Al-Adli; Siri Tummala; Michael C Oh

doi:10.1016/j.xnsj.2023.100292

Early radiographic outcomes after anterior cervical discectomy and fusion with anatomic versus lordotic cages

N Am Spine Soc J. 2023 Nov 15:17:100292. doi: 10.1016/j.xnsj.2023.100292. eCollection 2024 Mar.

Authors

Nadeem N Al-Adli¹, Siri Tummala¹, Michael C Oh²

Affiliations

¹ Texas Christian University School of Medicine, TCU Box 297085, Fort Worth, Texas 76129, USA.
² Methodist Moody Brain and Spine Institute, 1411 North Beckley Ave, Pavilion III, Suite 152, Dallas, TX 75203, USA.

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) interbody implants are shaped anatomically, with a convex superior aspect, or lordotically, with an angle and flat surfaces. However, the effect of implant shape on cervical sagittal balance (CSB) is not well described.

Methods: Of the 192 cases reviewed from 2018 to 2019, 118 were included with matching pre- and postoperative imaging. Cases were categorized by interbody implant type (anatomic or lordotic) and number of levels fused (1-level, 2-level, etc.). SurgiMap was used to measure cervical lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope (T1S), and T1S minus CL (T1S-CL) on pre- and postoperative imaging. Pre- and postoperative parameters were compared within and between each cohort. Change in CL (ΔCL), cSVA (ΔcSVA), and T1S-CL (ΔT1S-CL) were calculated as the difference between pre- and postoperative values and were compared accordingly (1) anatomic versus lordotic and (2) 1-level versus 2-level versus 3-level fusion.

Results: Thirty-nine (33.1%), 57 (48.3%), and 22 (18.6%) cases comprised the anatomic, lordotic, and mixed (anatomic and lordotic) groups, respectively. ACDFs improved CL and T1S-CL by 5.71° (p<.001) and 3.32° (p<.01), respectively. CL was improved in the lordotic (5.27°; p<.01) and anatomic (4.57°; p<.01) groups, while only the lordotic group demonstrated improvement in T1S-CL (3.4°; p=.02). There were no differences in ΔCL (p=.70), ΔcSVA (p=.89), or ΔT1S-CL (p=.1) between the groups. Two- and 3-level fusions improved CL by 7.48° (p<.01) and 9.62° (p<.01), and T1S-CL by 4.43° (p<.01) and 5.96° (p<.01), respectively.

Conclusions: Overall, ACDFs significantly improved CL and T1S-CL however, there were no differences in CSB correction between the anatomic and lordotic groups. Two- and 3-level fusions more effectively improved CL (vs. single-level) and T1S-CL (vs. 3-level). These results suggest that implants should continue to be personalized to the patient's anatomy, however, future research is needed to validate these findings and incorporate the effects of preoperative deformities.

Keywords: Anterior cervical discectomy and fusion; Cervical lordosis; Cervical sagittal alignment; Implant geometry; Interbody implant shape; T1 slope; T1 slope minus cervical lordosis.