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

Retrospective study design on prospectively collected registry data. 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. 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. 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. 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). 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 III.