The Use of Osteobiologics in Single versus Multi-Level Anterior Cervical Discectomy and Fusion: A Systematic Review.

"The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article."

"Funding: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This supplement was organized and financially supported by AO Spine through the AO Spine Knowledge Forum Degenerative, a focused group of international spine experts."

"The systematic review was registered into the PROSPERO database under number CRD42020199006. A PICO answering the main question was drafted by the team lead and co-lead and discussed with the entire review team via video conferencing. The PICO was subsequently reviewed by the AO-GO core team, to be able to seamlessly integrate it with the other 12 systematic reviews performed, in relation to the guideline development. The full PICO can be found as a supplemental document, Table 1. In short, we included adult patients between ages 18 and 80 years old with herniated or degenerative cervical neck discs. Exclusion criteria were: history of tumor; infection; spinal cord injury; trauma or fracture; skeletally immature patients or patients with scoliosis or other cervical deformity. Intervention was multi-level ACDF with cage and/or anterior plating and the use of an osteobiologic (see supplemental documents, Table 2). The comparator was single level ACDF with cage and/or anterior plating combined with iliac crest bone graft (ICBG) or allograft. Our primary outcome measure was fusion, determined either by CT or flexion/extension X-rays. Secondary outcome measures were patient reported outcome measures (PROMs). Only articles published after 2000 were considered for review."