Spine surgeons vary widely in how they assess fusion after anterior cervical discectomy and fusion, according to a study published Sept. 16 in Global Spine Journal.
Researchers surveyed 111 spine experts worldwide from Jan. 1 to Feb. 1, 2025; 44 responded, a 40% response rate. Experts were selected based on research impact and other criteria. Of 43 respondents who reported their region, 26 were from North America.
Among respondents, 78% said standardized radiographic criteria for determining fusion were very important, but only 50% reported familiarity with existing criteria. At 1 year, 87% of respondents used flexion-extension radiographs and 65% used CT.
The criterion most frequently rated as strong evidence of fusion was extra graft bridging bone of at least 2 mm with remodeling on CT, cited by 69% of respondents. Intraoperative observation with mechanical perturbation was cited by 67%, while 47% rated interspinous motion of less than 1 mm, alone or combined with angular motion of less than 5 degrees, as strong evidence. Up to 20% rated leading measures as moderate or poor evidence.
The researchers said the variation highlights the need for standardized, evidence-based criteria for assessing fusion after ACDF. They noted the 40% response rate limits generalizability to the broader spine community and that some regions were underrepresented.
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