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

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.