May 6, 2026Clinical Spine Surgery A Spine Publication0 citations

The Impact of Prior Fragility Fractures on Postoperative Outcomes in Anterior Cervical Discectomy and Fusion

MZMuhammad ZulfiqarUniversity of Virginia VVVed A. VengsarkarRutgers, The State University of New Jersey EDElizabeth DriskillUniversity of Virginia

Key Points

To evaluate the impact of prior fragility fractures on complications following anterior cervical discectomy and fusion.
Retrospective cohort study design
Patients with primary ACDF within 3 years of a fragility fracture identified
Control cohort without prior fragility fractures matched 1:1
Outcomes assessed included 90-day complications, 30-day and 90-day readmissions
Statistical analyses included Pearson χ2 test, Welch t test, multivariate logistic regression
Prior fragility fractures associated with higher medical complications such as atelectasis, respiratory failure, and urinary tract infections
Surgical complications included dysphagia and spinal cord deficits occurring more frequently
Subsequent fragility fractures significantly higher in patients with a history of fragility fracture
30-day and 90-day readmission rates significantly elevated for patients with fragility fractures

Abstract

Study Design: Retrospective cohort study. Objective: To evaluate the impact of prior fragility fractures on complications following anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Fragility fractures indicate poor bone quality and increased comorbidities, potentially elevating surgical risks. Understanding the risks is critical for optimizing outcomes in ACDF patients. Methods: Patients undergoing a primary ACDF within 3 years of a fragility fracture were identified from 2013 to 2022. A control cohort without prior fragility fractures was matched 1:1. Exclusion criteria included traumatic fractures, prior revision ACDFs, and active spine infections. Outcomes assessed included 90-day medical and surgical complications; 30-day and 90-day emergency visits and readmission rates; and 2-year complications, including mortality. Statistical analyses included the Pearson χ 2 test, the Welch t test, and multivariate logistic regression. Results: A total of 1236 patients were matched in each cohort. Prior fragility fractures were associated with higher risks of medical complications, such as atelectasis (4.4% vs. 1.7%, OR=2.83, P <0.001), respiratory failure (5.0% vs. 2.3%, OR=2.36, P <0.001), pleural effusion (3.6% vs. 0.9%, OR=4.35, P <0.001), and urinary tract infections (9.3% vs. 4.5%, OR=2.20, P <0.001). Surgical complications were also more frequent, including dysphagia (7.0% vs. 4.0%, OR=1.81, P =0.001), spinal cord deficit (5.0% vs. 2.1%, OR=27.46, P <0.001), and deep wound infection (1.2% vs. 0.4%, OR=3.07, P =0.031). Subsequent fragility fractures at 2 years were significantly higher in patients who had a history of fragility fracture (29.0% vs. 4.4%, OR=10.18, P <0.001), as were 30-day (12.5% vs. 7.3%, OR=1.87, P <0.001) and 90-day (16.8% vs. 10.3%, OR=1.82, P <0.001) readmission rates. Conclusions: Patients with a history of fragility fractures undergoing ACDF experience significantly higher rates of postoperative complications and readmission rates.

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