Orthosis Free One Level Anterior Cervical Discectomy and Fusion Using Stand Alone Cage

Abstract

Background Data: The anterior cervical discectomy and fusion (ACDF) operation has gained much popularity since its introduction in the 1950s by Smith and Robinson. Despite the biomechanical advantages of cage with or without plate application, the use of cervical collars or external cervical orthosis (ECO) after instrumented anterior cervical fusion is stillwidely practiced. Purpose: Our study aims at documenting the clinical and radiological outcomes of patients that had one level ACDF using standalone cage without the use of ECO in the postoperative period taking in consideration the results of other similar studies in the literature. Study Design: Retrospective cohort study on 50 patients that sufferedone-level cervical disc pathology in the form of degenerative spondylosis, radiculopathy or myelopathy. Outcome measures include visual analogue scale to compare the degree of neck and arm pain, Neck Disability Index, mean local segmental cervical angle, fusion, and mean disc height preoperative and six months and two years postoperative.Patients and Methods: Fifty patients had one level ACDF using standalone PEEK cage filled with autogenous iliac crest bone graft during the period between December 2009 and December 2013. Thirty one were females (62%) and nineteen were males (38 %). The indications for surgery were symptomatic single-level cervical spondylotic radiculopathy or myelopathy that had failed medical treatment for at least 6 weeks. Important exclusion criteria were traumaticinstability, severe osteoporosis, infection and tumors. Results: Fifty patients had one level ACDF with standalone cage, the correlation between both preoperative mean VAS for neck and arm pain and that after 6 months and 2 years postoperativereveals highly significant improvement with P-value 0.0001. In the meantime, concerning neck disability index (NDI) the correlation between preoperative mean and that at 6 months and 2 years postoperative showed significant improvement with P-value 0.0001. Conclusion: In comparison to the results in the literature demonstrating the outcomes of both ACDFwith the usage of ECO and without in the postoperative period, our results show that the use of a cervical brace does not improve the fusion rate or the clinical outcomes of patients undergoing singlelevel ACDF using standalone PEEK cage filled with autogenous iliac crest bone graft. (2016ESJ106)