Complications With Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-Level Anterior Cervical Discectomy and Fusion Surgery

Juan P Cabrera; Sathish Muthu; Mohamed Kamal Mesregah; Ricardo Rodrigues-Pinto; Neha Agarwal; Viswanadha Arun-Kumar; Yabin Wu; Gianluca Vadalà; Christopher Martin; Jeffrey C Wang; Hans Jörg Meisel; Zorica Buser; AO Spine Knowledge Forum Degenerative

doi:10.1177/21925682231157320

Complications With Demineralized Bone Matrix, Hydroxyapatite and Beta-Tricalcium Phosphate in Single and Two-Level Anterior Cervical Discectomy and Fusion Surgery

Global Spine J. 2024 Feb;14(2_suppl):78S-85S. doi: 10.1177/21925682231157320.

Authors

Affiliations

¹ Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Chile.
² Faculty of Medicine, University of Concepción, Concepción, Chile.
³ Department of Orthopaedics, Government Medical College, Dindigul, India.
⁴ Orthopaedic Research Group, Coimbatore, India.
⁵ Department of Orthopaedic Surgery, Menoufia University Faculty of Medicine, Shebin El-Kom, Egypt.
⁶ Spinal Unit/Unidade Vertebro-Medular (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto, Porto, Portugal.
⁷ Department of Neurosurgery, BG Klinikum Bergmannstrost Halle, Germany.
⁸ Reva Spine Centre, Visakhapatnam, AP, India.
⁹ Research Department, AO Spine, AO Foundation, Davos, Switzerland.
¹⁰ Campus Bio-Medico University of Rome and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
¹¹ Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
¹² USC Spine Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
¹³ Gerling Institute, Brooklyn, NY, USA.
¹⁴ Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York, NY, USA.

Abstract

Study design: Systematic literature review.

Objectives: To analyze the evidence available reporting complications in single or two-level anterior cervical discectomy and fusion (ACDF) using a demineralized bone matrix (DBM), hydroxyapatite (HA), or beta-tricalcium phosphate (β-TCP).

Methods: A systematic review of the literature using PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov databases was performed in August 2020 to identify studies reporting complications in one or two-level ACDF surgery using DBM, HA, or β-TCP. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Results: A total of 1857 patients were included, 981 male and 876 female, across 17 articles; 5 prospective, and 12 retrospectives. We noted heterogeneity among the included studies concerning the study design and combination of graft materials utilized in them. However, we noted a higher incidence of adjacent segment disease (17.7%) and pseudoarthrosis (9.3%) in fusion constructs using DBM. Studies using β-TCP reported a higher incidence of pseudoarthrosis (28.2%) and implant failures (17.9%).

Conclusions: Degenerative cervical conditions treated with one or two-level ACDF surgery using DBM, HA, or β-TCP with or without cervical plating are associated with complications such as adjacent segment disease, dysphagia, and pseudarthrosis. However, consequent to the study designs and clinical heterogeneity of the studies, it is not possible to correlate these complications accurately with any specific graft material employed. Further well-designed prospective studies are needed to correctly know the related morbidity of each graft used for achieving fusion in ACDF.

Keywords: anterior cervical discectomy and fusion; beta-tricalcium phosphate; complications; demineralized bone matrix; dysphagia; hydroxyapatite; pseudarthrosis.