[Comparison of ROI-C and traditional cage with anterior plating for anterior cervical discectomy and fusion].

Abstract

To study clinical outcomes following anterior cervical discectomy and fusion (ACDF) using ROI-C compared to traditional cage with anterior plating in treating the cervical spondylotic myelopathy. A total of 66 patients with the cervical spondylotic myelopathy were treated with ACDF between April 2011 and October 2012. Twenty-three patients underwent ACDF using the ROI-C device were classified as the ROI-C group and 43 patients received traditional cage with anterior plating served as the titanium plate group. Related indicators, such as operation time, intraoperative blood loss, intraoperative fluoroscopy times, incidence of postoperative dysphagia and ratio of bone graft fusion were recorded and compared between two groups. The clinical outcomes were evaluated by Japanese Orthopaedic Association (JOA) scores and visual analog scale (VAS) scores. The pre- and postoperative results were compared with a paired sample t-test. The results between groups were compared utilizing the grouped t-test or χ² test. All cases were followed up. The follow-up period was 12 to 38 months and 14 to 39 months in ROI-C group and titanium plate group respectively. For the age, gender, the JOA scores, VAS scores of neck pain and arm pain during preoperative, the surgical level constituent ratio and the follow-up time, there were no significant differences between two groups. In ROI-C group, the operation time was (123 ± 38) minutes, intraoperative blood loss was (84 ± 37)ml, exposure times to the X-ray C-arm machine was (3.5 ± 0.7) times, which were all significantly lower than titanium plate group ((165 ± 60) minutes, (128 ± 66) ml, (5.9 ± 1.2) times respectively, t = -3.27, -3.25, - 9.45, P = 0.02, 0.02, 0.00). The mean JOA scores increased significantly from pre-surgery to 1 month postoperatively, 3 months postoperatively, and last follow-up in ROI-C group (t = 11.94, 11.32, 10.60, all P = 0.00) and titanium plate group(t = 15.07, 19.51, 17.55, all P = 0.00). The mean VAS scores of neck pain and arm pain decreased significantly from pre-surgery to 1 month postoperatively, 3 months postoperatively, and last follow-up in ROI-C group (t = -16.64-- 9.68, all P = 0.00) and titanium group(t = -16.56--12.38, all P = 0.00). There was no significant difference on JOA scores and VAS scores of neck pain and arm pain between the two groups at the same time (P > 0.05). However, significant difference was observed in incidence of postoperative dysphagia (χ² = 6.79, P = 0.01). In addition, bony fusion was obtained in all cases at the last follow-up postoperatively. There was no significant difference on ratio of bone graft fusion between two groups. The ROI-C leads to similar clinical outcomes compared to traditional cage combined with anterior plating for the treatment of the cervical spondylotic myelopathy, while the ROI-C carries a simpler operation, shorter operation time, less intraoperative blood loss, less exposure times to the X-ray and a lower risk of postoperative dysphagia.