ArticleJournal of spine surgery (Hong Kong)2026
Clinical and radiographic outcomes of three-level anterior cervical discectomy and fusion using allograft cellular bone matrix.
Article in Journal of spine surgery (Hong Kong), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Achieving reliable fusion in multilevel anterior cervical discectomy and fusion (ACDF) remains challenging, with increasing rates of pseudarthrosis and approach-related complications as the number of fused levels increases. Selection of an optimal biologic adjunct is particularly important in three-level constructs, yet data on allograft cellular bone matrix (ACBM) remain limited. This study describes the clinical and radiographic outcomes of patients undergoing three-level ACDF augmented with ACBM. Methods: A retrospective cohort study was conducted at a single academic institution. A total of 103 adults who underwent primary three-level ACDF with ACBM augmentation between 2012 and 2020 and had a minimum of 24 months of follow-up were included. Medical records and imaging were reviewed for demographic characteristics, perioperative variables, complications, and outcomes. Functional outcomes were assessed using the Neck Disability Index (NDI) and Visual Analog Scale (VAS) scores for neck and arm pain. Fusion was evaluated using serial plain radiographs, with advanced imaging obtained selectively when findings were equivocal. Changes in NDI and VAS scores from baseline to 24 months were analyzed using paired Student's Results: The mean follow-up duration was 45.5±15.5 months. Patients demonstrated significant improvements in functional outcomes, with mean NDI improving from 26.4±8.2 preoperatively to 11.2±4.5 at 24 months (P<0.001). Mean VAS-neck scores improved from 7.7±2.9 to 2.4±1.6 (P<0.001), and mean VAS-arm scores improved from 5.2±3.4 to 1.4±1.1 (P<0.001). Radiographic pseudarthrosis was identified in five patients (4.9%), with four remaining asymptomatic and one requiring revision posterior fusion. Postoperative dysphagia occurred in 24 patients (23.3%), with the majority of cases resolving by six months and no cases of severe dysphagia or airway compromise. Symptomatic adjacent segment disease (ASD) developed in six patients (5.8%) during follow-up. Conclusions: In this retrospective cohort, three-level ACDF augmented with ACBM was associated with meaningful improvements in pain and functional outcomes, and a low incidence of pseudarthrosis. These findings support the feasibility of ACBM as a biologic adjunct in multilevel anterior cervical fusion.
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