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European Spine Journal

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Open Access 01-02-2019 | Review Article

Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review

Authors: I. Noordhoek, M. T. Koning, C. L. A. Vleggeert-Lankamp

Published in: European Spine Journal | Issue 2/2019

Abstract

Purpose

Anterior cervical discectomy and fusion (ACDF) has proven effective in treating radicular arm pain. Post-operatively, cervical spine stability is temporarily challenged, but data on bony fusion and speed of fusion are ambiguous; optimum evaluation method and criteria are debated.

Aim

To study bony fusion accomplishment and to obtain an overview of methods to evaluate fusion.

Methods

A literature search was performed in PubMed and Embase. Included studies had to report original data concerning 1- or 2-level ACDF with intervertebral device or bone graft, where bony fusion was assessed using CT scans or X-rays.

Results

A total of 146 articles comprising 10,208 patients were included. Bony fusion was generally defined as “the presence of trabecular bridging” and/or “the absence of motion”. Fusion was accomplished in 90.1% of patients at the final follow-up. No gold standard for assessment could be derived from the results. Addition of plates and/or cages with screws resulted in slightly higher accomplishment of fusion, but differences were not clinically relevant. Eighteen studies correlated clinical outcome with bony fusion, and 3 found a significant correlation between accomplishment and better clinical outcome.

Conclusions

In approximately 90% of patients, bony fusion is accomplished one year after ACDF. As there is no generally accepted definition of bony fusion, different measuring techniques cannot be compared to a gold standard and it is impossible to determine the most accurate method. Variations in study design hamper conclusions on optimising the rate of bony fusion by choice of material and/or additives. Insufficient attention is paid to correlation between bony fusion and clinical outcome.

Graphical abstract

These slides can be retrieved from electronic supplementary material.

Available only for authorised users

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Title: Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review
Authors: I. Noordhoek
M. T. Koning
C. L. A. Vleggeert-Lankamp
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 2/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-018-5820-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review

Abstract

Purpose

Aim

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Aim

Methods

Results

Conclusions

Graphical abstract

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