Three-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Papadopoulos, E.; Huang, Russel C.; Girardi, Federico P.; Synnott, Keith; Cammisa, Frank P.

doi:10.1097/01.brs.0000209348.17377.be

Cited by 125 publications

(88 citation statements)

References 41 publications

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“…Our series had a union rate of 93.3 % (14/15) in ACCF groups, which is higher than the ACDF group, although there was no significant difference. The clinical outcomes of ACDF and ACCF are similar in many studies [1,3,15,16]. In our series, both groups demonstrated a significant increase in JOA scores and a significant decrease in VAS scores that were maintained at the 5-year follow-up.…”

Section: Discussionsupporting

confidence: 84%

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

2012

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Purpose We evaluated radiologic and clinical outcomes to compare the efficacy of anterior cervical discectomy and fusion (ACDF) and anterior corpectomy and fusion (ACCF) for multilevel cervical spondylotic myelopathy (CSM). Methods A total of 40 patients who underwent ACDF or ACCF for multilevel CSM were divided into two groups. Group A (n = 25) underwent ACDF and group B (n = 15) ACCF. Clinical outcomes (JOA and VAS scores), perioperative parameters (length of hospital stay, blood loss, operation time), radiological parameters (fusion rate, segmental height, cervical lordosis), and complications were compared. Results Both group A and group B demonstrated significant increases in JOA scores and significant decreases in VAS. Patients who underwent ACDF experienced significantly shorter hospital stays (p = 0.031), less blood loss (p = 0.001), and shorter operation times (p = 0.024). Both groups showed significant increases in postoperative cervical lordosis and achieved satisfactory fusion rates (88.0 and 93.3 %, respectively). There were no significant differences in the incidence of complications among the groups. Conclusions Both ACDF and ACCF provide satisfactory clinical outcomes and fusion rates for multilevel CSM.However, multilevel ACDF is associated with better radiologic parameters, shorter hospital stays, less blood loss, and shorter operative times.

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Section: Discussionsupporting

confidence: 84%

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

2012

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“…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. This drastic difference in pseudoarthrosis rate following multilevel fusions emphasises the importance of using plate augmentation, although the interbody fusion material used in the current study was a cage, which differs from the autogenous iliac bone used in the previous reports.…”

Section: Discussionmentioning

confidence: 99%

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

2012

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Introduction Three-or four-level anterior cervical discectomy and fusion with autograft and plate fixation have demonstrated relatively good fusion rates and outcomes, but donor site morbidity and the limitations of autograft harvest remain problematic. The purpose of this study is to assess the radiographic and clinical outcomes of three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Methods This retrospective review included 43 consecutive patients who underwent three-or four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct (three level: 39 cases, four level: 4 cases). The fusion rate, time to fusion, Cobb angle and disc height were assessed radiographically. Clinical outcomes were evaluated with the VAS, NDI, and SF36 scores. Complications were also recorded. Results Solid fusion was achieved in all the patients, and mean time to fusion was 13.7 ± 5.1 weeks. The postoperative Cobb angle, lordotic angle, and disc height (5.6°, 10.5°a nd 3.15 mm, respectively) increased significantly compared to preoperative values (p = 0.038, p = 0.032, and p = 0.0004, respectively), and these improvements were maintained through final follow-up. The postoperative NDI (17.2), VAS (2.8), and SF36 (13.1) scores increased significantly compared to the preoperative scores (p = 0.026, p = 0.0007 and p = 0.041, respectively). Complications included three cases of respiratory difficulty, four cases of dysphagia and one case of hoarseness. There were no cases of donor site morbidity. Conclusions Three-or four-level anterior cervical discectomy and fusion with a PEEK cage, and plate construct provide good clinical and radiographic outcomes including high fusion rates, low complication rates, low donor site morbidity, and good maintenance of the lordotic angle and disc height in the treatment of multilevel cervical spondylosis.

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“…Reviewing the literature as regards multilevel anterior cervical fusion supplemented by stabilisation revealed a tendency towards the application of anterior plating rather than posterior instrumentation [1,5,7,12,13,18]. This is of course advantageous in terms of avoiding performing an additional surgery with a new posterior wound.…”

Section: Why Posterior and Not Anterior Instrumentationmentioning

confidence: 99%

“…Anterior cervical plating with tricortical iliac graft became in the later years the gold standard for cervical fusion and was applied for multilevel disease by several authors. The rate of fusion obtained was more than 90 % in most of the series [5,18]. Hwang et al studied multilevel cervical disc disease treated with titanium cage fusion with and without addition of anterior plating.…”

Section: Union and Pseudoarthrosismentioning

confidence: 99%

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

2012

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Purpose Anterior cervical decompression and fusion is a well-established procedure for the treatment of cervical spinal canal stenosis. In this study, we evaluated the necessity of spinal instrumentation after four-level anterior cervical decompression and cage fusion. Methods From January 2006 until August 2008, 25 patients (8 females and 17 males) (mean age 63.9 ± 7.9 years) suffering from spinal stenosis C3-C7 underwent anterior decompression and interbody fusion. The patients were divided into two groups. Four-level discectomy and cage fusion was performed in all patients. In group A including nine patients, posterior instrumentation with a lateral mass screw-rod system was added, while in group B including 16 patients, additional instrumentation was not performed. The mean duration of follow-up was 48.6 months (average 25-67 months). Results Clinically, the mean value for the Neck Disability Index improved from 40 ± 23.25 at presentation to 16.31 ± 15.09 at the final follow-up. The difference between the two groups was statistically not significant. Radiologically, the criteria for solid bony fusion were achieved successfully in all patients of group A, and in 87.5 % of patients in group B. The difference between the two groups was statistically not significant. The fused segment was then evaluated in the sagittal radiographs as regards the height and the lordosis angle. The loss in the height as well as the loss in the lordosis angle was more when posterior instrumentation was not added. However, the difference between the two groups was not statistically significant. Conclusion Stand-alone intersomatic cage fusion is an acceptable line of treatment for four-level cervical disc disease, both clinically and radiologically. Although the addition of posterior instrumentation yields better radiological results, the difference does not reach the statistical significance level.

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Three-Level Anterior Cervical Discectomy and Fusion With Plate Fixation

Abstract: Three-level anterior cervical discectomy with plate fixation has a high rate of fusion, a low complication rate, and acceptable outcome in the treatment of multilevel cervical spondylosis.

Cited by 125 publications

References 41 publications

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study

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

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

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