Thorough Comparative Analysis of Stand-Alone Cage and Anterior Cervical Plate for Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Disease: A Systematic Review and Meta-analysis

Abstract

In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.

Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies

“…37 According to several reviews of the literature, functional outcomes for primary APC and SAAS using JOA, NDI, and VAS are comparable. [38][39][40][41][42][43][44] Our meta-analysis confirmed the same findings as primary APC and SAAS, as both lead to improvements in JOA, VAS, and NDI in revision surgery. This similarity should be interpreted with caution due to the inherent differences between primary and revision surgery.…”

Vertebral Body Sliding Osteotomy as a Surgical Strategy for the Treatment of Cervical Myelopathy: Complications and Pitfalls

“…Dysphagia frequently occurs following anterior approach-related cervical surgeries, including ACDF and ACCF [ 16 - 18 ]. In the previous study, dysphagia was the most common complication following ACDF, observed in 9.5% of patients [ 16 ].…”

A Retrospective Evaluation and Review of Radiographic Outcomes for Anterior Cervical Discectomy and Fusion (ACDF) Procedures: Northern Ireland's Experience

“…This has historically provided successful arthrodesis and restored segmental stability. Since the 1980s, anterior plating has been common practice, improving the fusion rate and maintaining cervical lordosis in both single-level and multi-level cases ​[ 3 , 6 ]. However, plating is not without complications, with multiple studies reporting significant incidences of dysphagia and screw migration ​[ 7 , 8 ].…”

“…Despite providing superior bone fusion and cervical alignment, anterior plating is not without complications. Due to possible soft tissue irritation, dysphagia is relatively common in patients with anterior plating compared to those treated solely with the Cage [ 3 ]. This has prompted the development of alternative devices, one such example being the Zero-profile augmented screw implants (Z-P) ​[ 5 ]​.…”

“…Numerous studies have since suggested that the use of the stand-alone cage alone results in segmental kyphosis and loss of disc height. It has been hypothesised that the progressive vertebral body wedging observed in patients treated with this construct causes subsequent kyphosis [2][3][4]. Multiple centres perform anterior plate fixation in addition to Cage implantation to prevent these complications.…”