Increased Fusion Rates With Cervical Plating for Two-Level Anterior Cervical Discectomy and Fusion

Abstract

Study Design. A retrospective review of all patients surgically treated with a two-level anterior cervical discectomy and fusion with and without anterior plate fixation by a single surgeon.Objectives. To compare the clinical and radiographic success of two-level discectomy and the effect of anterior cervical plate fixation.Summary of Background Data. Prior studies of multisegment fusions have shown decreased fusion rates correlating with the number of increased levels. The use of anterior plates for single-level cervical fusions is controversial. However, their use in multilevel fusions may be warranted because of the increased pseudarthrosis rates.Methods. Over a 6-year period, 60 patients were treated surgically with a two-level anterior cervical discectomy and fusion by the senior author. Thirty-two patients had cervical plates, and 28 underwent fusions without plates. These patients were followed for an average of 2.7 years. Clinical and radiographic follow-up evaluations were performed.Results. Of the 60 patients, 7 had a pseudarthrosis. The pseudarthrosis rates were 0% for patients with plating and 25% for those with no plating. This difference was statistically significant (P ϭ 0.003). No correlation of pseudarthrosis with gender, age, level of surgery, history of tobacco use, or the presence of prior anterior surgery was found. There was significantly less graft collapse (P ϭ 0.0001) in the patients without plates in whom pseudarthrosis developed (1.4 mm) than in those who had fusions with plates (0.3 mm). The amount of kyphotic deformity of the fused segment was 0.4°in patients with plating compared with 4.9°in those without plating who developed a pseudarthrosis (P ϭ 0.0001).Conclusions. The addition of plate fixation for twolevel anterior cervical discectomy and fusion is a safe procedure with no significant increase in complication rates. The pseudarthrosis rates are significantly higher in patients treated without plate fixation. No nonunions occurred in the patients treated with plate fixation. There was significantly less disc space collapse and kyphotic deformity with the plated fusions than with the nonplated fusions, in which a pseudarthrosis developed. The complication rates for plated fusions are extremely low and do not differ from those for nonplated fusions.

Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct

“…Geisler et al [29] reported a 100 % fusion rate in 35 plated multilevel (three-and four-level) ACDFs. Wang et al [30] found that 18 % (7 of 40) of the patients had pseudarthrosis after three-level plated ACDF, and they observed no difference in fusion rates between plated and nonplated subgroups. Bolesta et al [3] reported a nonunion rate of 53 % (8/15 patients) for plated ACDF, the highest in the literature.…”

“…Song et al [5] found that ACDF with a cage and plate construct led to a high fusion rate in the treatment of single-level degenerative cervical disease and also led to acceptable intervertebral disc space and lordosis. Emery et al [4] and Wang et al [30] studied the development of pseudoarthrosis after multilevel fusion without plate augmentation, and both reported high pseudoarthrosis rates of 44 and 37 %, respectively. Papadopoulos et al [31] implemented plate augmentation in multilevel fusions and found that only two of their 46 cases (4 %) developed pseudoarthrosis.…”

Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up

“…Multilevel stand-alone cages were reported to be associated with high rates of pseudarthrosis [32]. To increase fusion rates, prevent subsidence and restore cervical sagittal alignment, additional anterior cervical plating has been recommended for cage fixation [29].…”

Four-level anterior cervical discectomies and cage-augmented fusion with and without fixation

“…Because of increased biomechanical stress and the number of bony interfaces, the pseudoarthrosis rate after a multisegmental anterior cervical fusion is directly correlated with the number of levels treated [11,22]. In 1997, Emery et al retrospectively reviewed 16 patients undergoing anterior cervical discectomy and stand-alone graft fusion for three-level disease.…”