• Zachariah W Pinter, Anthony Mikula, Matthew Shirley, Ashley Xiong, Giorgos Michalopoulos, Abdul Karim Ghaith, Scott Wagner, Benjamin D Elder, Brett A Freedman, Ahmad Nassr, Mohamad Bydon, Bradford Currier, KayeI DavidIDDepartment of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Christopher Kepler, and Arjun S Sebastian.
• Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Pinter.Zachariah@mayo.edu.
• World Neurosurg. 2023 Feb 1; 170: e700e711e700-e711.

ObjectiveThe purpose this study was to precisely characterize patterns of allograft subsidence following anterior cervical discectomy and fusion (ACDF) utilizing computed tomography scans, determine risk factors for cervical allograft subsidence, and investigate the impact of subsidence on pseudarthrosis rates.MethodsWe performed a retrospective review of patients undergoing 1-to 3-level ACDF utilizing allograft interbodies with anterior plating between 2011 and 2019. Subsidence measurements were performed by 2 independent reviewers on computed tomography scans obtained 6 months postoperatively. Subsidence was then classified as mild if subsidence into the inferior and superior endplates were both ≤2 mm, moderate if the worst subsidence into the inferior- or superior endplate was between 2 and 4 mm, or severe if the worst subsidence into the inferior- or superior endplate was ≥4 mm. Multivariate analysis was performed to identify risk factors for the development of subsidence.ResultsWe identified 98 patients (152 levels) for inclusion. A total of 73 levels demonstrated mild subsidence (≤2 mm), 61 demonstrated moderate subsidence (2-4 mm), and 18 demonstrated severe subsidence (≥4 mm). On multivariate analysis, risk factors for severe subsidence included excessive vertebral endplate resection and lower screw tip to vertebral body height ratio. Severe subsidence was associated with an increased rate of pseudarthrosis (94.1% vs. 13.6%) without an associated increase in reoperation rate.ConclusionsFollowing ACDF with allograft interbodies, 50% of interbodies will subside >2 mm and 10% of interbodies will subside >4 mm. Risk factors for severe subsidence should be mitigated to decrease the risk of pseudarthrosis.Copyright © 2022 Elsevier Inc. All rights reserved.

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