Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up

Abstract

To avoid complications associated with plating in anterior cervical discectomy and fusion (ACDF), stand-alone anchored PEEK cage was developed and favourable outcomes with a low rate of dysphasia have been described. The objective of this study was to compare the clinical and radiological outcomes of ACDF using a standalone anchored PEEK cage (PREVAIL; Medtronic Sofamor Danek, Memphis, TN) with those of a PEEK cage with plating in a prospective randomized manner. Fifty patients with single-level cervical radiculopathy were randomly assigned to a PREVAIL or a PEEK cage with plating. Following 3, 6, 12, and 24 months, clinical and radiological outcomes were assessed. The mean surgical time for the patients with a PREVAIL was significantly shorter than that for those with a PEEK cage with plating. The clinical outcomes evaluated by visual analogue scale for pain and the Odom's criteria were comparable between both the groups. Both the groups demonstrated the high fusion rate (92% in PREVAIL; 96% in PEEK cage with plating). The subsidence rate and the improvement of cervical alignment were comparable between both the groups. The incidence of adjacent-level ossification was significantly lower for patients with a PREVAIL than that for those with a PEEK cage with plating. The rate of dysphasia graded by the method of Bazaz and measurement of prevertebral soft tissue swelling indicated no significant differences between both the groups. Our prospective randomized study confirmed that stand-alone anchored PEEK cage is a valid alternative to plating in ACDF with a low rate of adjacent-level ossification. However, the potential to reduce the incidence of dysphasia was not confirmed.

Comparison among perfect-C®, zero-P®, and plates with a cage in single-level cervical degenerative disc disease

“…However, dysphagia is a relatively common complication after ACDF. Although no definitive mechanism has been proven, swelling due to traction, hematoma, and nerve injury such as the pharyngeal nerve plexus and the hypoglossal nerve during operation are considered risk factors [15]. Duan et al [18] reported that the incidences of dysphagia in patients administered the Zero-P device were significantly lower than those in patients using a plate and cage.…”

“…The composition of an anterior cervical plate and an interbody cage in ACDF is possible to increase fusion rates compared with the ACDF without anterior plates [12,14]. Numerous articles have reported the effective use of placing plates to prevent pseudoarthrosis, subsidence, and local kyphosis [15]. However, the addition of a plate may cause softtissue injury, dysphagia, plate fracture, and migration.…”

“…The rates of HO in our groups were 0% (Perfect-C and Zero-P groups) and 30% (Plate-with-Cage group) at the last follow-up visit, which corresponded to significant differences among groups. Although the mechanism of HO is known, the association of anterior structures, such as the anterior longitudinal ligament or anterior fibers of the annulus fibrosis, and other technical ad biomechanical considerations related to plating could be regarded as contributing factors [15].…”

The Norwegian Cervical Arthroplasty Trial (NORCAT): 2-year clinical outcome after single-level cervical arthroplasty versus fusion—a prospective, single-blinded, randomized, controlled multicenter study

“…Stand-alone polyetheretherketone (PEEK) cage implant as used in the NORCAT differs from most other comparable trials, where allograft and anterior plating are most commonly used [6][7][8][9][10][11]. The reported fusion rates between the two techniques after 2 years are, however, similar at 97.5% [6], 94.3% [7], and 92.1% [11] for allograft with plating and 92% [34] for stand-alone PEEK cage. Nemoto and colleagues [34] recently assessed clinical outcome and complications regarding postoperative dysphagia between stand-alone cage implant versus cage and anterior plating in single-level cervical disc disease, and found no difference between the two surgical methods.…”

Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life

“…In a prospective randomized study, the stand-alone anchored PEEK cage was confirmed as a valid alternative to plating in ACDF with a low rate of adjacent-level ossification (39). ACDF with standalone spacers has resulted in similar clinical and radiologic outcomes as compared with plate and spacers and may help minimize postoperative dysphonia (40).…”