Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression

Study Design. Reconstruction techniques after multi-level anterior cervical decompression were retrospectively compared. Objective. To compare radiographic and clinical outcomes of multiple interbody grafting with strut grafting. Summary of Background Data. Previous studies have reported lower fusion rates for anterior cervical decompressions reconstructed with multiple interbody grafts as opposed to a single strut graft, although these techniques have never been directly compared in a consecutive series of patients who underwent surgery by a single surgeon. Methods. Over a 20-year period, 190 patients underwent anterior cervical decompression and autogenous grafting without internal fixation and were followed for an average of 68 months. There were 98 two-level and 33 three-level discectomies with interbody grafting, These were compared with 16 one-level, 21 two-level, 20 three-level, and 2 four-level corpectomies with strut grafting. Radiographic and clinical outcomes were compared between the groups by chi(2) and rank-sum analysis, respectively. Results. Of the 59 patients who underwent strut grafting, 55 achieved a solid arthrodesis (93%), as compared with 87 of the 131 patients who underwent multiple interbody grafting (66%) (P = 0.0002). There were six cases of graft displacement or extrusion among the 59 patients who had strut grafts, as compared with no graft-related complications among the 131 patients who had interbody grafts (P < 0.0001). More good and excellent clinical outcomes were found among patients who underwent strut-grafting (88% vs 84%), although the difference was not statistically significant (P = 0.73). However, patients with a pseudarthrosis had significantly poorer clinical outcomes (P < 0.0001). Conclusions. A much higher fusion rate was achieved after corpectomy and strut grafting than after multilevel discectomy and interbody grafting. Although there were strut graft-related complications, four of these six complications occurred among patients who had a postlaminectomy kyphosis. Because pseudarthrosis resulted in poorer clinical outcomes, strut grafting should be considered after multilevel anterior cervical decompression to increase the likelihood of successful fusion.