Effects of Anterior Plating on Achieving Clinically Meaningful Improvement Following Single-Level Anterior Cervical Discectomy and Fusion

Abstract

Objective:The clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2-years following ACDF.Methods: Patients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROM) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: SF-12 PCS 8.1, VAS neck 2.6, VAS arm 4.1, NDI 8.5. Rates of MCID achievement were compared between groups. Results:The cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6-weeks. Rates of MCID achievement differed significantly between groups for NDI at 6-weeks, and 12-weeks, and SF-12 PCS overall. Conclusion:Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall.

The Effect of Subsidence on Segmental and Global Lordosis at Long-term Follow-up After Anterior Cervical Discectomy and Fusion

“…Recent studies have compared clinical outcomes and subsidence rates between ACDF with and without cervical plating. 24 Lee et al 25 found that subsidence rates were higher when cervical fusions were performed without plating. In our study, all fusions were performed with plating or with a zero-profile cage with integrated screws.…”

“…The effect of subsidence on lordosis may depend on variations of ACDF surgery including but not limited to cervical plating, revision following cervical disc arthroplasty, and multilevel fusion. Recent studies have compared clinical outcomes and subsidence rates between ACDF with and without cervical plating [ 24 ]. Lee et al [ 25 ] found that subsidence rates were higher when cervical fusions were performed without plating.…”

Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling

“…If non-surgical treatment is unsuccessful, anterior cervical discectomy and fusion (ACDF) is considered the best surgical treatment 3 – 6 . During ACDF, a conventional cage and plate (CCP) implant is often used, which prevents interbody graft dislocation and improves sagittal alignment, interbody fusion rate, and stability 1 , 5 , 7 . CCP implants, which are thinner than earlier models, do however have limitations such as the development of postoperative dysphagia, adjacent segment degeneration, and soft tissue injury 1 , 3 , 8 – 11 .…”