Titanium Cage Versus Structural Allograft for Anterior Cervical Discectomy and Fusion: A Propensity Score Matched...

Retrospective cohort study.

To understand the strengths of titanium cages for ACDF using a propensity score matched analysis while characterizing radiologic and clinical outcomes associated with graft material.

Structural allografts and synthetic grafts such as titanium cages have been frequently utilized for anterior cervical discectomy and fusion (ACDF). Although the biomechanical properties have been compared between these 2 graft types, there remains limited data on their comparative performance for cervical procedures.

We assembled a cohort of patients who underwent an ACDF with a structural allograft or titanium cage at a tertiary care medical center and community hospital by a single surgeon. To compare outcomes, 1:1 propensity score matching was performed using optimal pair matching and a generalized linear model.

Of 376 patients, 269 received a structural allograft and 107 a titanium cage [median age: 56 y, 51.6% (n=194) female, 22.9% (n=86) current smokers]. Almost half of ACDFs (161 patients, 42.8%) were multilevel fusions. Across both graft materials, ACDFs had a relatively safe complication profile with a low intraoperative blood loss. There was durable symptom relief, with 94.5% (n=345 of 365) of patients reporting improved to resolved symptoms at last follow-up. Patients with titanium cages had significantly greater cervical Cobb angle change compared with patients with structural allografts (P<0.001). After propensity score matching, patients with titanium cages had a lower estimated blood loss (P=0.03) and shorter hospital length of stay (P<0.001). However, there were no significant differences in rates of fusion, cage subsidence, pseudoarthrosis, or revision surgery.

Titanium cages demonstrate a similar safety and efficacy profile to structural allografts and may enable greater cervical Cobb angle changes. Longer neurosurgical follow-up may be required to assess need for revision procedures and quantitative patient-reported outcomes across cage materials.