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

Abstract

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.

Preliminary 12-Month Safety and Efficacy Outcomes for the Treatment of Cervical Radiculopathy and Myelopathy with the Stalif-C Integrated Interbody Fusion Device

“…Using a more lenient cutoff of 4 degrees or less of angular motion to assess fusion status, we found that 82.5% of levels would meet this criteria. Using stringent radiographic criteria to assess for fusion status, the observed fusion rate was lower than previously reported literature fusion rates of 84%-96% [30][31][32]. While it is important to report short term radiographic data, it is unclear whether the observed fusion rate is clinically significant.…”

Multilevel anterior cervical discectomy and fusion using zero-profile anchored cages: a minimum 5-year follow-up study

“…ACDF has been one of the standard treatments for cervical spondylopathy since it was rst described in the 1950s [16,17]. For multilevel lesions, although many prefer the posterior approach to achieve broader indirect decompression[18], the anterior approach has the characteristic of direct decompression of the neurological structures, less interference with posterior muscles, and hence less surgical trauma [19][20][21][22]. As experience with the anterior cervical plate has accumulated, the advantages of an enhanced fusion rate, better cervical spine realignment, and lordosis maintenance have been proven [23].…”

Stand-alone anterior cervical decompression and fusion surgery: A cohort study evaluating a shaped cage without plates or screws

“…APC as the standard technique in ACDF is effective in maintaining cervical stabilization, improving cervical lordotic alignment, preventing cage dislocation, and increasing fusion rates. Previous studies showed the efficacy and safety of using ACDF with cage and plate for signal level or multilevel patients with cervical spondylotic conditions ( 15 , 17 ). However, increased complication rates associated with plate fixation have been reported in patients with multilevel ACDF ( 15 , 17 ).…”

“…Previous studies showed the efficacy and safety of using ACDF with cage and plate for signal level or multilevel patients with cervical spondylotic conditions ( 15 , 17 ). However, increased complication rates associated with plate fixation have been reported in patients with multilevel ACDF ( 15 , 17 ). In order to overcome these complications, stand-alone cages were developed and used.…”