National Multicenter Analysis of Iliac Crest Bone Graft or Cage in Anterior Cervical Discectomy and Fusion Surgery

STUDY DESIGN: Retrospective study design on prospectively collected registry data. OBJECTIVE: To compare clinical outcomes and complication rates between anterior cervical discectomy and fusion (ACDF) using iliac crest bone graft with plate or cage with plate. SUMMARY OF BACKGROUND DATA: ACDF is an effective surgical treatment for cervical degenerative radiculopathy. Restoring the disk space with iliac crest bone graft yields good outcomes; however, it is associated with donor site pain and complications. The alternative, using an interbody cage, may delay bony union. MATERIAL AND METHODS: Patients who underwent ACDF for cervical degenerative radiculopathy using either iliac crest bone graft with plate or cage with plate were identified in the Swedish Spine Registry. Patient-reported outcome measures (PROMs) included the neck disability index (NDI), quality of life, and numeric pain rating scale scores. PROM improvements after two years of follow-up as well as postoperative complications and reoperations, were compared between the iliac crest bone graft and cage groups. Multivariable mixed-effects regression analyses were used to analyze factors associated with NDI improvement, complications, and reoperations while accounting for inter-facility variability. RESULTS: Included participants were 225 in the iliac crest group and 1288 in the cage group. Both groups achieved comparable postoperative PROMs, with a median NDI improvement of -20 (iliac crest) and -18 (cage) points, respectively. The rate of late reoperations (after 30 d) was significantly lower in the cage group than in the iliac crest group (odds ratio: 0.19, 95% CI: 0.05-0.76, P =0.02). CONCLUSIONS: At two years of follow-up, ACDF with a cage and plate achieved postoperative outcomes comparable to those of with an iliac crest bone graft and plate. Moreover, the study findings suggest that the cage represents a safer alternative to the iliac crest bone graft. LEVEL OF EVIDENCE: Level III.