Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient

• Main Authors: Majd Marrache, Rachel Bronheim, Andrew B. Harris, Varun Puvanesarajah, Micheal Raad, Sang Lee, Richard Skolasky, Amit Jain
• Format: Article
• Language: English
• Published: Korean Spinal Neurosurgery Society 2020-12-01
• Series: Neurospine
• Subjects: anterior cervical discectomy and fusion; radiculopathy; reoperation; hospital costs; allografts; synthetic cage
• Online Access: http://www.e-neurospine.org/upload/pdf/ns-2040216-108.pdf
• ISSN: 2586-6583; 2586-6591

Objective The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology. Methods We queried a private claims database to identify adult patients (≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05. Results A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of allcause reoperation compared to the allograft group (9.1% vs. 8.0%, p = 0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p < 0.001). Conclusion Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.