Anterior Cervical Discectomy and Fusion With “Kissing” Allograft Interbodies

Background: There is recent evidence to suggest that the use of polyetheretherketone (PEEK) interbodies are inherently associated with a higher rate of pseudarthrosis, in particular, at the C5-6 and C6-7 levels. Herein, we describe our technique utilizing two parallel structural allografts or “kissing” allografts, designed to mitigate the risk of pseudarthrosis and subsidence at these levels. Materials and Methods: We retrospectively reviewed all anterior cervical discectomy and fusion (ACDF) procedures with “kissing” for degenerative spine pathology at a single institution between 2018 and 2019 for the C5-6 and C6-7 levels. One-year postoperative flexion/extension cervical X-rays were evaluated for evidence of radiographic pseudarthrosis and subsidence. Results: A total of 28 patients met the study criteria. Solid fusion was achieved in 93%. There were no infections or wound complications. One patient developed postoperative dysphagia that resolved at 3-months post-op. Two patients were found to have clinically asymptomatic radiographic pseudarthrosis that did not warrant intervention. One patient developed a postoperative hematoma that required surgical evacuation. Conclusions: “Kissing” allograft ACDF is a safe and effective method designed to address the intrinsically higher risk of pseudarthrosis at the C5-6 and C6-7 levels. Further prospective studies are warranted to comparatively evaluate this technique against single allograft and PEEK interbodies.