Do the Choice of Fusion Construct With and Without Autograft Influence the Fusion and Complication Rates in Patients Undergoing 1 or 2-Level Anterior Cervical Discectomy and Fusion Surgery? A PRISMA-Compliant Network Meta-Analysis.

Study Design: Network meta-analysis.

Objectives: To compare the fusion outcome and complications of different 1 or 2-level anterior cervical decompression and fusion (ACDF) constructs performed with and without the application of autografts.

Methods: We performed an independent and duplicate search in electronic databases including PubMed, Embase, Web of Science, Cochrane, and Scopus for relevant articles published between 2000 and 2020. We included comparative studies reporting fusion rate and complications with and without the use of autografts in ACDF across 5 different fusion constructs. A network meta-analysis was performed in Stata, categorized based on the type of fusion constructs utilized. Fusion constructs were ranked based on p-score approach and surface under cumulative ranking curve (SUCRA) scores. The confidence of results from the analysis was appraised with Cochrane's CINeMA approach.

Results: A total of 2216 patients from 22-studies including 6 Randomized Controlled Trials (RCTs) and 16 non-RCTs were included in network analysis. The mean age of included patients was 49.3 (±3.62) years. Based on our meta-analysis, we could conclude that use of autograft in 1- or 2-level ACDF did not affect the fusion and mechanical implant-related complications. The final fusion and mechanical complication rates were also not significantly different across the different fusion constructs. The use of plated constructs was associated with a significant increase in post-ACDF dysphagia rates [OR 3.42; 95%CI (.01,2.45)], as compared to stand-alone constructs analysed.

Conclusion: The choice of fusion constructs and use of autografts does not significantly affect the fusion and overall complication rates following 1 or 2-level ACDF surgery.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Depuy Synthes. Medtronic, Baxter, SafeOrthopaedics, Croatian Society of Vertebrology. Medtronic Paid consultant for company, SI Bone Research support to institution, AO Spine Research support to institution, Mizuho Orthopedics Systems Research support to institution. ATEC-attended course in San Diego, travel and lodging supported by ATEC, ATEC-own stock options that were purchased personally. Zimmer, Depuy, Seaspine, various lawfirms, AO Foundation Board reimbursements, AO Foundation Board, Bone biologics Personal investment, Surgitech Personal investment, Pearldiver Personal investment. Fehling Instruments GmbH, Stayble Therapeutics Via Regenerate Life Sciences GmbH, Mundipharma Via Regenerate Life Sciences GmbH, Spinplant GmbH. SeaSpine (past, paid to the institution), Next Science (paid directly to institution), Motion Metrics (past, paid to the institution), NIH SBIR grant NIH SBIR Subaward, MAX BioPharma, Cerapedics (past), The Scripps Research Institute (past), AO Spine (past), Xenco Medical (past), AO Spine, North American Spine Society, US 2014O194364A1, US010391142B2, North American Spine Society: committee member, Lumbar Spine Society: Co-chair Educational Committee, AOSpine Knowledge Forum Degenerative: Associate member, AOSNA Research committee- committee member.