The Impact Plate Application on the Sagittal Plane Correction after Anterior Cervical Discectomy and Fusion Compared to Stand Alone Cage.

Abstract

Background Data: Anterior cervical discectomy and fusion (ACDF) is the treatment of choice for cervical degenerative disc disease, which causes neurological symptoms such as radiculopathy and/or myelopathy. Anterior cervical discectomy and fusion with stand-alone cage (ACDF-CA) is a successful option to treat cervical disc disease, but long-term follow-up showed complications like cage subsidence and pseudoarthrosis. Then, anterior cervical decompression and fusion with cage and plate (ACDF-CP) was developed to decrease complications of the stand-alone cage; however, it showed complications like dysphagia. Study Design: This is a retrospective clinical case series. Purpose: To compare the role of anterior plate constructs (ACDF-CP) and stand-alone cage (ACDF-CA) in maintaining sagittal plane correction. Patients and Methods: We retrospectively reviewed the lateral cervical radiographs of all patients who underwent ACDF-CA or ACDF-CP between 2011 and 2015. Radiological findings (cervical lordosis, segmental lordosis, cage subsidence, and disc height) were compared (preoperatively, immediately, and 6 and and 12 months postoperatively). Results: Sixty-five patients underwent ACDF, including 88 operative disc levels, 29 (44.6%) ACDF-CA, and 36 (55.6%) ACDF-CP. There were 41 (63.1%) males and 24 (36.9%) females, with a mean age of 47.7 ± 9.32 years. Forty percent of the procedures were conducted by orthopedic spine surgeons and 60% by neurosurgeons. The most common operated level was C5-C6 followed by C6-C7. Initially, ACDF-CA showed better surgical correction than ACDF-CP in terms of cervical lordosis and segmental lordosis but did not reach the statistically significant value (p = 0.692, CI: [-4.8]-7.28), whereas ACDF-CP maintains these corrections more than ACDF-CA at final follow-up despite being statistically insignificant (p = 0.506, CI: [-7.05]-3.54). No difference was detected in disc height and cage subsides between the two groups. Conclusion: The data in this study may suggest that the ACDF-CA construct was slightly better than ACDF-CP in the surgical correction of the cervical curve, whereas ACDF-CP maintained the correction at final follow-up despite the insignificant statistical value. (2020ESJ216)