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Alec W. Gibson, Abdullah H. Feroze, Madeline E. Greil, Margaret E. McGrath, Sananthan Sivakanthan, Gabrielle A. White-Dzuro, John R. Williams, Christopher C. Young, and Christoph P. Hofstetter


Anterior cervical discectomy and fusion (ACDF) is the most common treatment for degenerative disease of the cervical spine. Given the high rate of pseudarthrosis in multilevel stand-alone ACDF, there is a need to explore the utility of novel grafting materials. In this study, the authors present a single-institution retrospective study of patients with multilevel degenerative spine disease who underwent multilevel stand-alone ACDF surgery with or without cellular allograft supplementation.


In a prospectively collected database, 28 patients who underwent multilevel ACDF supplemented with cellular allograft (ViviGen) and 25 patients who underwent multilevel ACDF with decellularized allograft between 2014 and 2020 were identified. The primary outcome was radiographic fusion determined by a 1-year follow-up CT scan. Secondary outcomes included change in Neck Disability Index (NDI) scores and change in visual analog scale scores for neck and arm pain.


The study included 53 patients with a mean age of 53 ± 0.7 years who underwent multilevel stand-alone ACDF encompassing 2.6 ± 0.7 levels on average. Patient demographics were similar between the two cohorts. In the cellular allograft cohort, 2 patients experienced postoperative dysphagia that resolved by the 3-month follow-up. One patient developed cervical radiculopathy due to graft subsidence and required a posterior foraminotomy. At the 1-year CT, successful fusion was achieved in 92.9% (26/28) of patients who underwent ACDF supplemented with cellular allograft, compared with 84.0% (21/25) of patients who underwent ACDF without cellular allograft. The cellular allograft cohort experienced a significantly greater improvement in the mean postoperative NDI score (p < 0.05) compared with the other cohort.


Cellular allograft is a low-morbidity bone allograft option for ACDF. In this study, the authors determined favorable arthrodesis rates and functional outcomes in a complex patient cohort following multilevel stand-alone ACDF supplemented with cellular allograft.

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Seiichi Odate, Jitsuhiko Shikata, Tsunemitsu Soeda, Satoru Yamamura, and Shinji Kawaguchi

consists of a combination of progressive kyphosis, segmental instability due to preceding posterior decompression, massive OPLL causing anterior neural compression, and an ossified posterior longitudinal ligament (PLL) that is often strongly adherent to the dura or dural ossification due to its long duration. We hypothesized that revision ACDF in such situations might be associated with a high possibility of surgery-related complications and a low improvement rate in terms of neurological function. The purpose of this study was to investigate the surgical results and

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Matthew S. Erwood, Beverly C. Walters, Timothy M. Connolly, Amber S. Gordon, William R. Carroll, Bonita S. Agee, Bradley R. Carn, and Mark N. Hadley

surgery, current diagnosis, and patient demographic data. Revision Surgery Using a 2-Team Approach Sixty-seven patients undergoing revision ACDF were enrolled. In all instances, the previous surgery was via the right side and the study surgery was conducted via a reoperative right anterior transcervical approach. Dissection was performed through scar by the double team of surgeons. The head and neck surgeon obtained exposure to the necessary spinal levels through the soft tissues of the neck. The neurosurgeon then completed the revision ACDF surgical procedure and

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Kevin T. Huang, Michael A. Silva, Alfred P. See, Kyle C. Wu, Troy Gallerani, Hasan A. Zaidi, Yi Lu, John H. Chi, Michael W. Groff, and Omar M. Arnaout

between human review of images with and without the aid of this technique, as well as metrics on amount of time saved in the operative workflow, will be essential to establishing clinical utility. It has not escaped our attention that although this study focuses on the specific case of revision ACDF surgery, the classification of hardware types has applications elsewhere in neurosurgery. Any hardware that can be easily differentiated via its radiopaque profile, such as ventricular shunt valves or implantable pulse generators, could be similarly classified. In different

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Michael Y. Wang and Barth A. Green


Cervical stenotic myelopathy can be treated via anterior or posterior approaches. In anterior cervical decompression and fusion (ACDF), because the risks and likelihood of pseudarthrosis increase with the number of treated segments, attempts are typically made to limit the number of treated levels. Thus, postoperative recurrence of myelopathy following ACDF may occur because stenotic levels were not treated or because adjacent segments have degenerated. Revision decompressive surgery via an anterior approach is one solution; however, if the stenosis involves multiple levels a posterior decompressive laminoplasty can be performed as an alternative.


Twenty-four cases treated over an 8-year period were identified and data were retrospectively reviewed. In 15 cases posterior decompressive surgery was necessary because of progressive spinal degeneration and stenosis (five cases following initial treatment for radiculopathy, seven after initial treatment for spondylotic myelopathy, and three due to spreading of an ossified posterior longitudinal ligament). In nine cases revision surgery was undertaken because the initial decompression was inadequate.

The mean follow-up period after the second surgery was 16 months. Improvements in myelopathy were seen in 83% of patients (mean improvement of 1.25 points on the Nurick Scale). Preoperative severe gait disorders were associated with poor recovery. Complications included two cases of transient C-5 nerve root palsy and two cases of new persistent axial neck pain.


Laminoplasty is a straightforward and effective treatment for failed ACDF due to inadequate decompression or progressive degeneration of the spinal column, avoiding reentry through scar tissue. In terms of myeolpathic pain, the recovery rate is comparable with that related to revision ACDF.

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Matthew S. Erwood, Mark N. Hadley, Amber S. Gordon, William R. Carroll, Bonita S. Agee, and Beverly C. Walters

result of retraction, compression through inflation of the endotracheal cuff, and from airway trauma during intubation. 2 Very little data are available, however, on the frequency of RLN injury after revision ACDF surgery. It has been proposed that anatomical differences from scarring after previous ACDF lead to greater rates of RLN injury during reoperative ACDF surgery. However, evidence in the literature of this notion is lacking. The goal of our study was to perform a meta-analysis on RLN injury after revision ACDF surgery. We hypothesized that the rate of RLN

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Sheeraz A. Qureshi, Steven McAnany, Vadim Goz, Steven M. Koehler, and Andrew C. Hecht

either a revision arthroplasty or a revision ACDF. Effectiveness of Surgical Procedure Cost-utility analysis, a type of CEA, allows for comparison of different health outcomes by measuring them all in terms of QALYs. Utility factors were assigned to all health states in the model to adjust survival for quality of life. The utility of a disease state is graded on a scale of 0–1 with 1 being perfect health and 0 being death. The outcome of any health intervention can then be calculated as the product of the increase in utility that it may cause and the time in

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Tim Adamson, Saniya S. Godil, Melissa Mehrlich, Stephen Mendenhall, Anthony L. Asher, and Matthew J. McGirt

body mass index (BMI) of patients was 28.5 ± 5.4. Most patients underwent primary ACDF (91.6%), and only 8.4% underwent revision ACDF. TABLE 1. Baseline characteristics and patient demographics of 1000 consecutive patients undergoing outpatient ACDF Demographics and Comorbidities Outpatient ACDF (%) Mean age ± SD 49.5 ± 8.6 Males 484 (48.4) ASA Class   1 195 (19.5)   2 741 (74.1)   3 64 (6.4)   4 0 (0.0) CAD 22 (2.2) COPD 8 (0.8) DM 83 (8.3) Osteoporosis 17 (1

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Sehan Park, Dong-Ho Lee, Saemin Hwang, Soohyun Oh, Do-yon Hwang, Jae Hwan Cho, Chang Ju Hwang, and Choon Sung Lee

dynamic radiographs (intraobserver reliability ICC = 0.848, interobserver reliability ICC = 0.825) and InGBB and ExGBB on CT scans (intraobserver reliability ICC = 0.872, interobserver reliability ICC = 0.827) was excellent. Complications No major neurological or wound complications were detected in either group. No pelvic donor site complications, such as hematoma or infection, occurred in the IC group. Four patients from the IC group underwent revision ACDF because of adjacent segment disease. Three patients from the IC group achieved solid fusion while 1 patient had

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Dil V. Patel, Joon S. Yoo, Brittany E. Haws, Benjamin Khechen, Eric H. Lamoutte, Sailee S. Karmarkar, and Kern Singh

were younger (47.9 vs 52.8 years), had a lower comorbidity burden (CCI score 1.0 vs 2.0), and underwent surgery on fewer levels (1–2 levels: 99.0% vs 87.8%) than the hospital cohort. Various determinants play a role in deciding on the best setting for an individual patient to undergo a surgical procedure. For instance, patients needing spinal fusion of more than 2 levels should have their procedure in a hospital setting because of the greater risk for complications. 18 Similarly, patients with altered neck anatomy or requiring a revision ACDF through dense scar