Stand-alone cervical cages versus anterior cervical plate in two level cervical anterior interbody fusion patients : clinical outcomes and radiologic changes

Abstract

Anterior cervical discectomy and fusion (ACDF) has become a standard surgical procedure for treating degenerative disc disease associated with radiculopathy or myelopathy. Relatively good results have been reported when performing ACDF with cage alone (ACDF-CA); however, controversy remains regarding the high incidence of complications such as cage subsidence, kyphotic deformity, and pseudoarthrosis. We compared and analyzed the radiologic and clinical outcomes of ACDF-CA and ACDF-CPC for the surgical treatment of two contiguous level degenerative disc disease of the cervical spine to evaluate the efficacy of metal plate augmentation. A total of 54 consecutive patients who underwent 2-level ACDF-CA or ACDF-CPC after suffering from cervical radiculopathy were divided into two groups; Group A (n=28) underwent ACDF-CA; Group B (n=26) underwent ACDF-CPC. Fusion rate, global and segmental kyphosis, disc height, and subsidence rate were assessed by radiolographs. Clinical outcomes were assessed using the Robinson`s criteria. Solid fusion was achieved in 96.43% (27/28) in group A and in 96.15% (25/26) in group B. Fusion segmental kyphosis of more than 5° occurred in 14.29% (4/28) of group A and in 7.69% (2/26) of group B; however, there was no statistical difference between the two groups (P>0.05). Subsidene occurred in 35.71% (10/28) of group A as compared to 11.54% (3/26) of group B (P<0.05). Clinical outcomes were similar in the two treatment groups. The use of cage and plate construct in 2-level ACDF results in shorter fusion duration, lower subsidence rate than that of cage alone; however, there is no significant difference in postoperative global and segmental alignment and clinical outcomes between groups.