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Allograft vs Bioactive Glass-Ceramic Cages in Anterior Cervical Discectomy and Fusion: Long-Term Randomized Trial
Yihyun Roh1, Maria Camila Pedraza Ciro1,2, Yanting Liu1,3
1Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
None:
Study designObservational extended follow-up of a randomized controlled trial.ObjectiveTo compare mid-to long-term clinical and radiographic outcomes of allograft vs bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) while preserving the original random allocation.MethodsAll patients randomized in the parent RCT underwent 1-2 level ACDF between August 2017-August 2022 (allograft n = 18; BG n = 22) were followed through August 2025. We compared patient-reported outcomes-neck disability index (NDI) and visual analogue scale (VAS)-cervical sagittal alignment, including C2-7 lordosis (CL), T1 slope, and T1 slope minus cervical lordosis (T1sCA), and CT-based subsidence using adjusted linear mixed-effects models (LMMs); fusion (Bridwell I-II) was compared between groups.ResultsAmong 40 patients, 90% had follow-up longer than 24 months with mean follow-up 53.5 ± 25.2 months. Both groups showed significant within-group improvements in all patient reported outcomes. However, at the last visit, between-group differences were non-significant for the primary endpoints: NDI (BG-allograft -0.98, 95% CI -9.17 to 7.21; P = .814) and C2-7 lordosis (BG-allograft -0.19°; P = .917). Other endpoints (VAS, T1sCA, subsidence, fusion) were likewise similar. No cage breakage or migration occurred; adverse events were minor.ConclusionOver multi-year follow-up, bioactive glass-ceramic cages provided equivalent clinical improvement and radiographic stability to allograft cages after ACDF.
