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Related Experiment Video

Updated: Dec 14, 2025

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Does screw length for primary two-level ACDF influence pseudarthrosis risk?

Nathan J Lee1, Meghana Vulapalli1, Paul Park1

  • 1Department of Orthopaedics, Columbia University Medical Center, The Och Spine Hospital at New York-Presbyterian, New York, NY, USA.

The Spine Journal : Official Journal of the North American Spine Society
|July 17, 2020
PubMed
Summary
This summary is machine-generated.

Shorter screws relative to vertebral body diameter (VB%) in anterior cervical discectomy and fusion (ACDF) increase pseudarthrosis risk. A VB% less than 75% is a significant predictor of fusion failure and poor outcomes.

Keywords:
Anterior cervical discectomy and fusionCorpectomyFixationIntraoperative complicationsPseudarthrosisScrew lengthUnicortical

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Area of Science:

  • Spine surgery
  • Orthopedic biomechanics
  • Fusion outcomes

Background:

  • Pseudarthrosis is a common complication after anterior cervical discectomy and fusion (ACDF), impacting patient outcomes.
  • While factors like smoking and osteoporosis are known risks, the optimal screw length relative to vertebral body diameter (VB%) for successful fusion remains understudied.

Purpose of the Study:

  • To investigate the impact of ACDF screw length, specifically the screw length relative to vertebral body diameter (VB%), on the risk of pseudarthrosis.

Main Methods:

  • A review of prospectively collected data from 85 patients undergoing primary two-level ACDF.
  • Screw length and vertebral body diameter (VB%) were measured; radiographic pseudarthrosis (interspinous motion [ISM] ≥1 mm) and patient-reported outcomes (Neck Disability Index [NDI]) were assessed up to 2 years post-surgery.

Main Results:

  • Overall fusion success was 92.9% at 1 year.
  • Patients with any screw VB% <75% had significantly lower fusion success (64.3%) compared to those with VB% ≥75% (98.6%).
  • A VB% <75% was an independent risk factor for radiographic pseudarthrosis (OR 77, p<.001) and associated with worse NDI scores.

Conclusions:

  • A vertebral body percentage (VB%) of less than 75% for screws in primary two-level ACDF is strongly associated with increased radiographic pseudarthrosis.
  • This VB% <75% threshold serves as a valuable intraoperative guide to help surgeons avoid unnecessarily short screws and improve fusion success.