Comparison of the clinical and radiologic outcomes obtained with single- versus two-level anterior cervical decompression and fusion using stand-alone PEEK cages filled with allograft

Yoon

et al. 2017

J Korean Neurosurg Soc

ObjectiveThe authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes.MethodsA total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs: subsidence, C2–C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain.ResultsIn the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups: however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425); fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31).ConclusionOur clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

Section: Introductionmentioning

confidence: 97%

A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

Yoon

et al. 2017

J Korean Neurosurg Soc

“…When single-level ACDF is performed, 83%–100% of radiographic fusion is reported with both techniques [18]. In multilevel cervical disease, bony fusion rates and postoperative sagittal balance have varied among studies as well as on the basis of parameters used for evaluation; fusion rates for multilevel cervical disc degenerative disease vary from 78%–100% [7,22]. Chen et al [7] reported similar rates of fusion between both techniques (APC versus LSC) in multilevel cervical disease (95.7% versus 92.3%).…”

Section: Discussionmentioning

confidence: 99%

Locking Stand-Alone Cage Constructs for the Treatment of Cervical Spine Degenerative Disease

Leo-Vargas¹,

Muñoz-Romero²,

Mondragón–Soto³

et al. 2019

Asian Spine J

Study Design Prospective case series study. Purpose Description of the outcome of stand-alone cervical cages for single and multilevel cervical degenerative spine disease. Overview of Literature The aim of anterior cervical discectomy and fusion (ACDF) for cervical spine disease is to improve patient symptoms and spine stability and restore lordosis. Locking stand-alone cages were developed with the goal of minimizing soft tissue disruption anterior to the vertebrae and reducing the profile of the construct by avoiding an anterior plate, thereby maximizing ACDF benefits. Methods This study comprises a case series of patients surgically treated between July 2015 and February 2018 who received single or multilevel ACDF with a zero-profile stand-alone cervical cage. Surgical and clinical preoperative evaluation and surgical outcomes were evaluated using pre- and postoperative Nurick, Visual Analog Scale (VAS), Neck Disability Index (NDI), Japanese Orthopedic Association (JOA) score for myelopathy scales, cervical Cobb angles, postoperative surgical complications, and fusion and subsidence rates. Results Fifty-three patients underwent ACDF; the mean age of these patients was 58.8 years, and their preoperative VAS, NDI, and JOA scores were 8.1, 31.6, and 15.3, respectively. The preoperative Cobb angle was 30.7°. Forty-five percent of patients had one-level, 54.7% had two-level, and 13.2% had three-level procedures. On preoperative magnetic resonance imaging, foraminal stenosis was present in 94.3% of patients, whereas medullar stenosis was present in 41.5%. The rate of complications was 5.7%: two patients had postoperative dysphagia (3.7%), and one patient had a surgical site hematoma. Mean postoperative follow-up time was 6.7 months; postoperative VAS, NDI, and JOA scores were 2.4, 15.9, and 15.8, respectively. Postoperative Cobb angle was 35.9°, fusion rate was 84.9%, and subsidence rate was 11.3%. Conclusions ACDF with zero-profile stand-alone cervical devices is an excellent option for cervical degenerative disc disease of one, two, and three levels, with similar results reported when using ACDF with either cage or plate.

Cukurova Medical Journal

“…After performing clinical and radiologic examination in the postoperative period, the results were found to be similar with those of other studies performed. Notably, the usage of anterior cervical discectomy and cages achieved satisfactory long-term results even without the use of anterior plaques 26,27,28,30 .…”

Section: Discussionmentioning

confidence: 99%

Bladed peek cage using the anterior approach in multiple-level degenerative cervical disc herniation: a case series of 156 patients

Bilgin

Çavuş

Ökten

et al. 2019

This study aimed to evaluate the efficacy of cervical discectomy with bladed peek cage and differences in clinical outcomes, complication rates, and radiological findings of patients with multiple-level cervical degenerative disc herniation in terms of age, sex, and number of levels. Materials and Methods: The following data were assessed: demographic data, patient complaints, symptoms, neurologic examination and radiologic findings, postoperative outcomes, and complications of surgery. We assessed 156 patients who had level 2, 3, and 4 cervical degenerative disc herniation detected between 2012 and 2018 via radiological examination. Results: Of the patients, 41.6% (n = 65) were men and 58.4% (n = 91) women. The patients were aged 32-76 years, with an average age of 50.68 years. Moreover, 85.2% (n = 133), 13.5% (n = 21), and 1.3% (n = 2) of patients presented with level 2, 3, and 4 cervical degenerative disc herniation, respectively. All patients received medications as a conservative treatment during the preoperative period, and 79.5% (n = 124) underwent physiotherapy. In terms of complications, five patients developed neurological deficit and one developed superficial wound infection during the early postoperative period. Conclusion: The fusion rate may be similar to the stabilization, and cervical region movements may be achieved after performing anterior cervical plaque surgery with cage as well as anterior cervical discectomy and bladed peek cage surgery in patients with level 2 or higher cervical degenerative disc herniation and/or cervical spondylosis. Amaç: Klinik çalışmamızda multıple seviyeli servikal dejenaratif disk hernilerinde (2-4 seviye) yaş, cinsiyet, seviye sayısı, şikayet ve bulgular gözönünde bulundurularak anterior servikal diskektomi ile beraber bıçaklı cage uygulaması ve cerrahi sonrası hastaların klinik düzelmeleri, komplikasyon oranları ve radyolojik olarak değerlendirilmeleri amaçlanmıştır. Gereç ve Yöntem: 2012-2018 yılları arasında 2,3 ve 4 seviyeli servikal dejeneratif disk hernisi tespit edilen 156 hastanın şikayet, semptom, nörolojik muayene, radyolojik bulgular ve cerrahi olarak uygulanan diskektomi ve bıçaklı kafes ile postoperatif sonuçlar ve komplikasyonlar değerlendirilmiştir. Bulgular: Hastaların %41.6'sı (65 hasta) erkek, %58.4'ü (91 hasta) kadındı. Yaş aralıkları 32-76 ve yaş ortalamaları 50.68'di. %85.2'si (133 hasta) iki mesafe, %13.5'i (21 hasta) üç mesafe, %1.3'ü (2 hasta) dört mesafe servikal disk hernisine sahipti. Hastaların hepsi daha önce konservatif tedavi olarak ilaç kullanmış ve %79.5'i (124 hasta) fizik tedavi görmüştü. Hastalar postoperatif 3-36 ay ortalama 18 ay izlendi. Komplikasyon olarak, postoperatif erken dönemde 5 hastada nörodefisit, 1hastada yüzeyel yara enfeksiyonu gelişti. Sonuç: İki ve daha fazla seviyeli servikal dejeneratif disk hernili ve spondilozlu hastalara uygulanan anterior servikal diskektomi ve bıçaklı kafes ameliyatları ile anterior plakla stabilizasyona gerek kalmaksızın servikal bölgenin hareketlerinin korunması sağlanabilir.