Moyamoya disease (MMD) is a chronic cerebrovascular disorder characterized by progressive stenosis or occlusion of the internal carotid arteries and the development of collateral moyamoya vessels. Surgical revascularization is commonly used to prevent future ischemic events in ischemic-type MMD, but there remains a high rate of stroke perioperatively. This study aims to analyze the predictive factors for perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization using a large multicenter database. We conducted a multicenter retrospective study in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. This study included patients with ischemic-type MMD who underwent surgical revascularization across 13 academic institutions in North America. Data were collected and analyzed on a per-hemisphere basis, covering patient demographics, disease characteristics, procedural details, and outcomes. Statistical analyses were performed using Stata (V.17.0), comparing baseline characteristics, and using univariable and multivariable logistic regression to identify predictors of perioperative stroke. A total of 301 patients with ischemic-type MMD underwent surgical revascularization, with 34 patients (11.3%) experiencing perioperative stroke. Patients who experienced perioperative stroke had a mean age of 43.6 years (SD 14.0) compared to 40.0 years (SD 13.9) in those without perioperative stroke (P=0.16). Hypertension was significantly more prevalent in the perioperative stroke group (73.5% vs. 47.9%, P=0.005). Current smoking was also more common in the perioperative stroke group (55.8% vs. 38.2%, P=0.04). Multivariate logistic regression identified hypertension (OR 2.32, 95% CI 1.01 to 5.37, P=0.04) and current smoking (OR 2.28, 95% CI 1.04 to 4.97, P=0.03) as significant independent predictors of perioperative stroke. Hypertension and smoking were significant predictors of perioperative stroke in patients with ischemic-type MMD undergoing surgical revascularization. These findings emphasize the importance of managing risk factors in ischemic-type MMD. Further prospective studies are needed to validate these findings.

Purpose: Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. The choice of fusion material for ACDF is crucial due to its influence on surgical outcomes and patient-reported outcome measures (PROM). While previous studies have evaluated radiological and perioperative outcomes, limited evidence exists on the impact of fusion materials on PROMs. This study aims to compare conventional surgical outcomes and PROMs between patients receiving synthetic cages and autologous crista grafts. Methods: This nationwide observational study utilized data from the Swedish Spine Registry (Swespine). All adults who underwent ACDF between 2006 and 2020 were eligible for inclusion. Patients with missing baseline or outcome data were excluded. Propensity score matching at a 2:1 ratio was performed to adjust for baseline differences. Results: 7,716 patients were included, with 92% ( n = 7,107) receiving synthetic cages and 8% receiving autologous crista bone grafts ( n = 609). After matching, the synthetic cage group showed significantly lower complication (1.6% vs. 3.1%, p = 0.028) and reoperation rates (2.5% vs. 4.6%, p = 0.014), and shorter hospital stays (2.14 ± 1.98 vs. 2.89 ± 2.05, p < 0.001). PROMs at 1-year follow-up revealed no significant differences in neck and arm pain (Numerical Rating Scale (NRS) scores), Neck Disability Index (NDI), European myelopathy score, or quality of life (EQ-5D, EQ-VAS). Satisfaction rates were comparable (74% vs. 72%, p = 0.72). Conclusion: In this matched analysis, synthetic interbody fusion cages were comparable to autologous crista bone grafts for ACDF, with no significant differences in PROMs at 1-year follow-up. However, synthetic cages were associated with lower complication rates, reoperation rates, and shorter hospital stays.