Outcome of Multilevel Anterior Cervical Discectomy and Fusion without plating

Abstract

Background & objectives: The safety and efficacy profile of stand-alone polyetheretherketone cages has been questioned in the management of patients with more than one cervical disc disease. In this article, we evaluated the idea of safety of multilevel anterior cervical discectomy and fusion, without using a plate and the achieved pain relief. Methods: In this study, retrospectively we reviewed 30 patients diagnosed with multilevel cervical disc disease (total 69 segments) due to degenerative changes, disc herniation, and/or osteophyte formation. They complained of axial neck pain and/or radiculopathy not responding to non-surgical measures. All the included subjects treated for more than one-disc disease using stand-alone polyetheretherketone. With minimum 2-years of regular, clinical and radiological follow up. We have assessed the patient for criterions defined for cage subsidence and protrusion, as well as pain assessment pre and postoperatively using the visual analog score. Results: we assessed 22 patients (73.3%) for two level pathology and 8 patients (26.7%) with three level diseases. Mean age was 48.2±8.9 years. Female to male ratio was (1.1:1). The most common segment involved was C5-6 segment in 83.3%. The pre-operative visual Analogue Score for axial neck pain 6.3±3.05 and radiculopathy 6.8±2.2 was decreased post-operatively to 2±1.3 points respectively. Subsidence and protrusion assessed by measurement of serial X rays and one patient 3.3% developed subsidence in 2 adjacent levels which is statistically not significant. No incidence of cage protrusion was detected. Conclusions: Multilevel anterior cervical discectomy and fusion without plating provide good fusion, low subsidence rate, stability provided by the cage with excellent pain improvement.