{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:20:00Z","timestamp":1780086000554,"version":"3.54.0"},"reference-count":49,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T00:00:00Z","timestamp":1691107200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["2019YFQ0002"],"award-info":[{"award-number":["2019YFQ0002"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Although high fusion rates have been reported for anterior cervical decompression and fusion (ACDF) in the medium and long term, the risk of nonfusion in the early period after ACDF remains substantial. This study investigates early risk factors for cage nonfusion in patients undergoing single\u2010 or multi\u2010level ACDF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective study. From August 2020 to December 2021, 107 patients with ACDF, including 197 segments, were enrolled, with a follow\u2010up of 3\u2009months. Among the 197 segments, 155 were diagnosed with nonfusion (Nonfusion group), and 42 were diagnosed with fusion (Fusion group) in the early period after ACDF. We assessed the significance of the patient\u2010specific factors, radiographic indicators, serum factors, and clinical outcomes. The Wilcoxon rank sum test, <jats:italic>t\u2010<\/jats:italic>tests, analysis of variance, and stepwise multivariate logistic regression were used for statistical analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Univariate analysis showed that smoking, insufficient improvement in the C2\u20107 Cobb angle (<jats:italic>p<\/jats:italic>\u2009=\u20090.024) and the functional spinal unit Cobb angle (<jats:italic>p<\/jats:italic>\u2009=\u20090.022) between preoperative and postoperative stages and lower serum calcium (fusion: 2.34\u2009\u00b1\u20090.12\u2009mmol\/L; nonfusion: 2.28\u2009\u00b1\u20090.17\u2009mmol\/L, <jats:italic>p<\/jats:italic>\u2009=\u20090.003) \u03b2\u2010carboxyterminal telopeptide end of type 1 collagen (\u03b2\u2010CTX) (fusion: 0.51 [0.38, 0.71]; nonfusion: 0.43 [0.31, 0.57], <jats:italic>p<\/jats:italic>\u2009=\u20090.008), and N\u2010terminal fragment of osteocalcin (N\u2010MID\u2010BGP) (fusion: 18.30 [12.15, 22.60]; nonfusion: 14.45 [11.65, 18.60], <jats:italic>p<\/jats:italic>\u2009=\u20090.023) are risk factors for nonfusion in the early period after ACDF. Stepwise logistic regression analysis revealed that poor C2\u20107 Cobb angle improvement (odds ratio [OR], 1.107 [1.019\u20131.204], <jats:italic>p<\/jats:italic>\u2009=\u20090.017) and lower serum calcium (OR, 3.700 [1.138\u201312.032], <jats:italic>p<\/jats:italic>\u2009=\u20090.030) are risk factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with successful fusion after ACDF had higher preoperative serum calcium and improved C2\u20107 Cobb angle than nonfusion patients at 3\u2009months. These findings suggest that serum calcium could be used to identify patients at risk of nonfusion following ACDF and that correcting the C2\u20107 Cobb angle during surgery could potentially increase fusion in the early period after ACDF.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13835","type":"journal-article","created":{"date-parts":[[2023,8,4]],"date-time":"2023-08-04T07:36:44Z","timestamp":1691134604000},"page":"2574-2581","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Risk Factors of Nonfusion after Anterior Cervical Decompression and Fusion in the Early Postoperative Period: A Retrospective Study"],"prefix":"10.1111","volume":"15","author":[{"given":"Zihan","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Orthopedic Research Institute, West China Hospital Sichuan University  Chengdu 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