Plate Construct versus Stand-Alone Cage in ACDF. Does the Plate Maintain a Sagittal Plane Correction: Clinical Outcome and Radiological Findings Correlation

Abstract

Introduction Anterior cervical discectomy and fusion (ACDF) is the treatment of choice of cervical degenerative disc disease which cause neurological symptoms include radiculopathy and myelopathy, and it can be done by different techniques which includes several options for implants like disc spacers made of autograft or allograft bone, porous metal, polyether ether ketone (PEEK) and anterior plates and screws. The purpose of this study is to compare the role of anterior plate constructs (ACDF-CPC) and stand-alone cage (ACDF-CA) in maintain of Sagittal plane correction, clinical and radiological findings. Material and Methods Retrospective study of 24 patients who underwent ACDF in Hamad General Hospital, 16 cases with ACDF-CA and 8 cases ACDF-CPC. Radiological findings (cervical lordosis, segmental lordosis, cage subsidence, disc height) and clinical outcome (Odom's criteria, dysphagia and swallowing problems) are compared (pre-op, 3–6 months post op, 12–18 months post op). Results Cervical Lordosis, segmental lordosis, and disc space height at the operated levels increased an average of 5.4°, 3.1°, and 1.5 mm in ACDF-CA and 3.2°, 3.4°, 3.5 mm in ACDF-CPC, with good to excellent result in ACDF-CA and fair to good result in ACDF-CPC according to Odom's criteria, with more dysphagia and dysphonia in ACDF-CPC. The maintaining of sagittal plane correction, disc space height, and cage subside are decrease during follow up in both groups, but clinical outcome was stable in most of the cases comparing to immediate post op finding. Conclusion Anterior cervical discectomy and fusion by stand-alone cage or anterior plate is achieved good clinical outcome and significant correction in sagittal plane and disc space height, but no significant difference between two groups in maintaining the sagittal plane correction and disc space.