Two-level anterior cervical discectomy and cage-assisted fusion without plates

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Anterior cervical discectomy (ACD) is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of the cervical spine. Based on data reported in the literature, fusion rates decrease significantly when more than one level undergoes surgery, and some authors recommend the addition of a plate system to improve results. At the authors' institution cervical carbon fiber cages (CFCs) are routinely used after ACD. They describe their experience in the treatment of 24 patients with two-level disease treated with CFCs alone.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Twenty-one patients with cervical radiculopathy and three with radiculomyelopathy underwent ACD. Surgery was performed at C5–6 and C6–7 in 18, at C4–5 and C5–6 in four, and at C3–4 and C5–6 in two patients. All the patients underwent magnetic resonance imaging and 15 also underwent computerized tomography (CT) to assess the results of surgery.</jats:p> <jats:p>Radiculopathy improved after surgery in all the cases, whereas myelopathy resolved in only one patient. At 1 year fusion was achieved in 96% of the surgically treated discs; this was verified on cervical spine x-ray films in all patients and on CT scans in three patients. Cervical lordosis was restored in eight of the nine patients in whom it was lost preoperatively. No complications related to cage extrusion and no cases of symptomatic pseudarthrosis were observed.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Interbody fusion cages have a load-sharing function and stabilize the spine to increase segmental stiffness, thus achieving fusion rates similar to those associated with bone grafts, even in multilevel disease.</jats:p></jats:sec>

Is the radiographic subsidence of stand-alone cages associated with adverse clinical outcomes after cervical spine fusion: an observational cohort study with 2-year follow-up outcome scoring

“…There were no significant differences between the two groups (p = 0.12, α = 0.05). The mean preoperative painDETECT score for the group of patients with subsidence was 13.3 (10-21), falling to 13.1 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) in mean time of follow-up 1 and 12.6 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) in mean time of follow-up 2. In the group of patients without subsidence, the mean Figure 4 Cervical spine (female, 66 years) with spinal stenosis in C5/6 and C6/7 and myelopathy treated by cervical cages in C5/6 and C6/7 -X-rays taken A immediately postoperatively, B 1 year after surgery without cage subsidence, and C 3 years postoperatively with osseointegration without subsidence.…”

“…Although the VAS indicated no significant improvement from before surgery to mean time of follow-up 1 (p = 0.09, α = 0.05) or between the two follow-ups, a significant improvement was noted between the preoperative VAS and mean time of follow-up 2 (p = 0.006, α = 0.05). On the painDETECT questionnaire, the total cohort scored 11.4 (mean; 4-21) preoperatively, which increased slightly in mean time of follow-up 1 to 11.8 (7-26) before dropping again in mean time of follow-up 2 to 10.9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). There were no significant improvements.…”

“…However, increasing cage subsidence in the endplates of the adjacent vertebral bodies following stand-alone treatment was striking. Although there is disagreement whether this subsidence affects stability or the outcome, in recent studies no such effect has been ascertained [20][21][22][23][24]. The aim of our study was to examine whether clinical outcome is impacted by postoperative cage subsidence and the resulting change in profile.…”

Comparing the rate of radiological and clinical adjacent segment degeneration after simple anterior cervical discectomy versus discectomy plus fusion

“…These findings showed that application of fusion after cervical discectomy helps improving preoperative alignment problems; however, ACD without fusion may cause new-onset alignment problems probably because of narrowing of the disc space. It was reported that abnormal movements due to these alignment issues may also cause adjacent segment problems (7,13,16,(18)(19)(20)(21)(22)(23) p<0.001). Those study results suggested that the primary cause of adjacent segment disease may be natural progression of cervical spondylosis (24).…”

High Rate of Fusion in Sheep Cervical Spines Following Anterior Interbody Surgery With Absorbable and Nonabsorbable Implant Devices

“…8 -10 However, titanium cages prevent adequate radiographic visualization of fusion and raise concerns regarding stress shielding of the bone. 11 Carbon fiber-reinforced polymer (CFRP) cages, which are radiolucent and have a modulus of elasticity closer to bone to prevent stress shielding, have been shown to achieve high fusion results of 93% to 100% without plating [12][13][14][15][16][17][18] when intraoperative, intervertebral distraction was used. Lower fusion rates were noted when surgery was performed without distraction.…”