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Influence of plate fixation on cervical height and alignment after one- or two-level anterior cervical discectomy and fusion

 Jaecheon Yu  ;  Yoon Ha  ;  Jun Jae Shin  ;  Jae Keun Oh  ;  Chang Kyu Lee  ;  Keung Nyun Kim  ;  Do Heum Yoon 
 BRITISH JOURNAL OF NEUROSURGERY, Vol.32(2) : 188-195, 2018-08 
Journal Title
Issue Date
Adult ; Aged ; Bone Plates* ; Cervical Vertebrae / diagnostic imaging* ; Diskectomy* ; Female ; Follow-Up Studies ; Humans ; Internal Fixators* ; Intervertebral Disc Degeneration / diagnostic imaging ; Intervertebral Disc Degeneration / surgery ; Lordosis / epidemiology ; Lordosis / etiology ; Male ; Middle Aged ; Neck Pain / epidemiology ; Neck Pain / surgery ; Neurosurgical Procedures ; Pain Measurement ; Postoperative Complications / epidemiology ; Retrospective Studies ; Spinal Fusion* ; Treatment Outcome
Anterior cervical discectomy fusion ; anterior cervical plate ; autologous bone ; stand-alone cage
Purpose: To evaluate the efficacy of plate fixation on cervical alignment after anterior cervical discectomy and fusion (ACDF) using a stand-alone cage (ACDF-CA), compared to ACDF performed using a cage and plate fixation (ACDF-CP) and ACDF using autologous iliac bone graft and plate fixation (ACDF-AP), for the treatment of one- or two-level cervical degenerative disease. A second objective was to assess the clinical and radiological outcomes between the groups. Methods: A total of 247 patients underwent ACDF and were divided into three groups: those who underwent ACDF-CA (n = 76), ACDF-CP (n = 82) or ACDF-AP (n = 89). Fusion rate and time-to-fusion, global cervical and segmental angle, fused segment height, subsidence rate, and clinical outcomes, were measured using the visual analogue scale (VAS), Oswestry Neck Disability Index (NDI), and Robinson's criteria, assessed preoperatively, immediately postoperatively, and at least 24 months, postoperatively. Results: ACDF-AP was associated with the shortest mean time-to-fusion, followed by ACDF-CP and ACDF-CA. Compared to the preoperative status, the fused segment height and segmental angle increased in all groups immediately postoperatively, being well-maintained in patients who underwent ACDF-AP, while decreasing in those who underwent ACDF-CP and ACDF-CA procedures. Global cervical lordosis increased with ACDF-AP, but decreased immediately postoperatively with ACDF-CP and ACDF-CA, and at the final follow-up. Univariate analysis confirmed that a change in fused segment height was positively associated with a change in both segmental and global cervical angles. Clinical outcomes, namely VAS and NDI scores, as well as Robinson's criteria, were comparable among the three techniques. Conclusions: Supplementation with plate fixation, especially using autologous iliac bone graft, is beneficial for maintaining the fused segment height and cervical spine curvature, as well as reducing time-to-fusion and subsidence rate.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Keung Nyun(김긍년)
Yoon, Do Heum(윤도흠) ORCID logo https://orcid.org/0000-0003-1452-5724
Ha, Yoon(하윤)
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