• I Noordhoek, M T Koning, and Vleggeert-Lankamp C L A CLA Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands..
• Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. i.noordhoek@lumc.nl.
• Eur Spine J. 2019 Feb 1; 28 (2): 386-399.

PurposeAnterior cervical discectomy and fusion (ACDF) has proven effective in treating radicular arm pain. Post-operatively, cervical spine stability is temporarily challenged, but data on bony fusion and speed of fusion are ambiguous; optimum evaluation method and criteria are debated.AimTo study bony fusion accomplishment and to obtain an overview of methods to evaluate fusion.MethodsA literature search was performed in PubMed and Embase. Included studies had to report original data concerning 1- or 2-level ACDF with intervertebral device or bone graft, where bony fusion was assessed using CT scans or X-rays.ResultsA total of 146 articles comprising 10,208 patients were included. Bony fusion was generally defined as "the presence of trabecular bridging" and/or "the absence of motion". Fusion was accomplished in 90.1% of patients at the final follow-up. No gold standard for assessment could be derived from the results. Addition of plates and/or cages with screws resulted in slightly higher accomplishment of fusion, but differences were not clinically relevant. Eighteen studies correlated clinical outcome with bony fusion, and 3 found a significant correlation between accomplishment and better clinical outcome.ConclusionsIn approximately 90% of patients, bony fusion is accomplished one year after ACDF. As there is no generally accepted definition of bony fusion, different measuring techniques cannot be compared to a gold standard and it is impossible to determine the most accurate method. Variations in study design hamper conclusions on optimising the rate of bony fusion by choice of material and/or additives. Insufficient attention is paid to correlation between bony fusion and clinical outcome. These slides can be retrieved from electronic supplementary material.

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