Long-Term Results of Multiple Anterior Cervical Discectomy with Cage Fusion Technique: Results of Multiple Centre Study

Abstract

BACKGROUND:Cervical herniation is commonly treated by anterior cervical discectomy and fusion (ACDF) if conservative management has failed in relief of the patient’s symptoms. Disc fusion is needed after ACDF as anterior longitudinal ligament will be absent after doing the operation, especially if multiple levels are needed. The occurrence of complications as cage subsidence and adjacent segment failure related to the length of follow up as they are increasing in percentage is directly proportional to the length of follow up.AIM:Analysis of the results for patients who underwent 3 levels of ACDF with cage fusion for short term and long term follow up in multiple centres as the visual analogue score for neck pain & brachialgia.METHODS:This retrospective cohort series of 68 patients selected out of 136 patients suffering from 3 levels of degenerative cervical disc disease who were unresponsive to adequate conservative therapy. All cases were treated at one of the neurosurgery departments of 3 different hospitals (Naser institute for research and treatment hospital, Haram hospital for research and treatment and Misr university for science and technology) by the same surgical team in the period from February 2012 to February 2017.RESULTS:We found in this study;68 patients fulfilling the inclusion criteria, of the 29 patients underwent 3 levels of ACDF starting from C3-4 (42.65%) and 39 patients who underwent 3 levels of ACDF starting from C4-5 (57.35%). Clinical assessment for VAS pain score for both neck pain and radiculopathy were done before the surgery and immediately post-operative and during each time follow up visit and we found statistically significant immediate postoperative improvement. (P < 0.05)CONCLUSION:Stand-alone three levels of an anterior cervical discectomy with cage fusion technique improved the clinical outcomes on long term follow up.

The Early Effect of Anterior Cervical Discectomy and Fusion on Adjacent Segment Degeneration in Cases of Cervical Degenerative Disease: A Clinical and Retrospective Study

“…Male patients were more than female patients [21], [23] unlike other two studies that had the https://oamjms.eu/index.php/mjms/index number of females more than that of males [12], [22]; this reveals that the difference in gender distribution shows no significance and no direct relation to development of ASD.…”

“…The age did not show statistical significance; all studies think that ASD could occur at any age, supporting the fact that cervical degenerative disease is an aging process but it has no direct effect on the timing of neither surgery nor its outcome [12], [21], [22], [23].…”

“…Patients who had developed new clinical manifestations showed only slight increase or worsening of Cobb's angle in the 2-year post-operative follow-up compared to the pre-operative, while the patients with no new clinical manifestations had significant increase the Cobb's angle; moreover, that the development of new pathology in the MRI done 2-year post-operative relative to the mean Cobb's was not significant; demonstrating that the correction of cervical lordosis and preserving cervical alignment correlates with ASDs (symptoms) but not necessarily with development of adjacent segment degeneration (radiological finding in the MRI), so we assume that cervical sagittal imbalance does not necessarily cause ASD in the form of radiological finding in the MRI, it is more related to developing neck pain reflected on Cobb's angle changes rather than new MRI findings; however, development of new pathology in the MRI was not necessarily associated with development of symptoms that cervical sagittal imbalance arising from cervical sagittal malalignment plays an independent role in exacerbating adjacent segment failure after multilevel fusion and should be considered during cervical fusion surgical planning [21], [23], [28], [30], [31].…”

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

“…Sun et al [34] performed a 5-year 3-level ACDF study and found 81 surgical levels were completely fused at the 5-year follow-up, but six levels remained unfused in the rst year after surgery. In a similar three-year study [35], the fusion rates at 1, 2, and 3 years after surgery were 77.9%, 94.1%, and 100%, respectively. In another study [36] involving 78 patients who also used the spinous processes criteria to assess fusion rate, all surgical levels were fused within the rst year.…”

Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study

“…However, few studies reported surgical, clinical, and radiologic outcomes after three-level contiguous ACDF without plating. 7,[9][10][11][12][13] This study aimed to investigate long-term clinical and radiological outcomes and complication rate after threelevel contiguous ACDF without plating for cervical DDD.…”