Titanium Cage Versus Structural Allograft for Anterior Cervical Discectomy and Fusion

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To understand the strengths of titanium cages for ACDF using a propensity score matched analysis while characterizing radiologic and clinical outcomes associated with graft material. SUMMARY OF BACKGROUND EVIDENCE: Structural allografts and synthetic grafts such as titanium cages have been frequently utilized for anterior cervical discectomy and fusion (ACDF). Although the biomechanical properties have been compared between these 2 graft types, there remains limited data on their comparative performance for cervical procedures. METHODS: We assembled a cohort of patients who underwent an ACDF with a structural allograft or titanium cage at a tertiary care medical center and community hospital by a single surgeon. To compare outcomes, 1:1 propensity score matching was performed using optimal pair matching and a generalized linear model. RESULTS: Of 376 patients, 269 received a structural allograft and 107 a titanium cage [median age: 56 y, 51.6% (n=194) female, 22.9% (n=86) current smokers]. Almost half of ACDFs (161 patients, 42.8%) were multilevel fusions. Across both graft materials, ACDFs had a relatively safe complication profile with a low intraoperative blood loss. There was durable symptom relief, with 94.5% (n=345 of 365) of patients reporting improved to resolved symptoms at last follow-up. Patients with titanium cages had significantly greater cervical Cobb angle change compared with patients with structural allografts (P