Clinical Outcomes between Stand-Alone Zero-Profile Spacers and Cervical Plate with Cage Fixation for Anterior Cervical Discectomy and Fusion: A Retrospective Analysis of 166 Patients.

Samuel Sommaruga,Kishan Patel,Luis Kolb,Enrico Tessitore,Granit Molliqaj,Shreyas Panchagnula,Aria Nouri,Joaquin Camara-Quintana,Michael Robinson,Xin Sun,Fjodor Melnikov,Joseph Cheng,Karl Schaller,Justin Virojanapa,Khalid Abbed

doi:10.3390/jcm10143076

Abstract

Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and/or radiculopathy who had ACDF with SA or CP from Jan 2013–Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 ± 69 vs. 126 ± 46 min) (p < 0.001), as was the average length of hospital stay (2.1 ± 2 vs. 1.5 ± 1 days) (p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35–0.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.

Highlights

Compression of the neural elements can lead to cervical radiculopathy, myelopathy, or myeloradiculopathy
Anterior approaches are often favored for patients with single level disc disease, kyphotic deformity and large focal anterior pathology [2]
In addition to demonstrating no statistically significant difference in morbidity of SA and cervical plating (CP) with respect to post-operative dysphagia, our study found no significant difference in intraoperative blood loss

Summary

Introduction

Degenerative disease of the cervical spine manifests in a wide spectrum of pathologies that encompass disc degeneration, disc herniation, vertebral restructuring, osteophyte formation, and ligamentous hypertrophy [1]. Compression of the neural elements can lead to cervical radiculopathy, myelopathy, or myeloradiculopathy. In the treatment of these pathologies, an anterior, posterior, or combined anterior/posterior surgical approach can be undertaken. Anterior approaches are often favored for patients with single level disc disease, kyphotic deformity and large focal anterior pathology [2]

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Conclusion