Self-locking Stand-alone Cage Research Articles

Hybrid fixation versus conventional cage-plate construct in 3-level ACDF: Introduce the “seesaw theory” of stand-alone cage

Study designA retrospective study. BackgroundConventional cage-plate construct (CCP) was widely used in anterior cervical discectomy and fusion (ACDF), but the rigid fixation limits the motion of fused segments. Self-locking stand-alone cage (SSC) was an alternative for ACDF procedures and showed several superiorities. However, the effect of hybrid fixation in 3-level ACDF remains unknown. ObjectiveTo assess the clinical and radiological outcomes of hybrid fixation with SSC and CCP against conventional CCP in 3-level ACDF. MethodA retrospective review of patients who underwent 3-level ACDF at Renji Hospital between January 2018 and December 2019 was performed. Eighty-three patients met the inclusion and exclusion criteria and were stratified into 2 groups based on the fixation methods. The clinical outcomes, functional outcomes, and radiological parameters were collected and analyzed. ResultsNo significant difference was observed between the two groups in the mean age, sex, body mass index, hospital stay, and duration of follow-up. The postoperative C2–7 Cobb angle in the CCP group was significantly greater than that in the hybrid group. The rate of cervical proximal junctional kyphosis (CPJK) in the hybrid group was significantly lower than that in the CCP group. The CCP group suffered significantly higher rates of adjacent segment degeneration (ASD) than the hybrid group at 2 years postoperatively. Moreover, the incidence of postoperative dysphagia was lower in the hybrid group. No significant differences were observed in JOA and NDI scores between the two groups. ConclusionThe hybrid fixation achieved comparable clinical outcomes against CCP fixation, indicating that hybrid fixation is an alternative procedure in 3-level ACDF.

Clinical and imaging outcomes of self-locking stand-alone cages and anterior cage-with-plate in three-level anterior cervical discectomy and fusion: a retrospective comparative study

BackgroundAnterior cervical discectomy and fusion has been considered standard management for cervical myelopathy and radiculopathy. However, the option of using self-locking stand-alone cages or cage-with-plate in three-level anterior cervical discectomy and fusion still remains controversial. The aim of this study was to evaluate the clinical and imaging outcomes of the two procedures in multilevel anterior cervical discectomy and fusion.MethodsSixty-seven patients who underwent three-level anterior cervical discectomy and fusion were enrolled in this study, of which 31 patients underwent surgery using self-locking stand-alone cages (group cage) and 36 patients using cage-with-plate (group plate). For the evaluation of clinical outcomes, modified Japanese Orthopedic Association scores, visual analogue scale for neck pain, neck disability index, Odom’s criteria and dysphagia status were measured. Imaging outcomes were evaluated by cervical sagittal angle, fusion segmental Cobb’s angle, fusion segmental height, range of motion, cage subsidence rate, fusion rate and adjacent segment degeneration. Statistical analyses were performed using the SPSS software (version 19.0).ResultsBoth groups showed improvement in modified Japanese Orthopedic Association scores, visual analogue scale for neck pain and neck disability index, after surgery, and there was no significant difference between the groups. The occurrence rate of dysphagia is significantly lower in the group cage compared with the group plate (p < 0.05). The postoperative cervical sagittal angle, fusion segmental Cobb’s angle, fusion segmental height and cage subsidence rate in the group plate were significantly superior to that in the group cage (p < 0.05). However, the rate of adjacent segment degeneration was significantly lower in the group cage compared with the group plate (p < 0.05). Both groups showed no significant difference in terms of fusion rate (p > 0.05).ConclusionsThe self-locking stand-alone cages are effective, reliable and safe in anterior cervical discectomy and fusion for the treatment of cervical myelopathy and radiculopathy. Self-locking stand-alone cages showed a significantly lower rate of dysphagia and adjacent segment degeneration, while anterior cervical cage-with-plate could provide stronger postoperative stability and maintain better cervical spine alignment.

Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-alone Cage and Conventional Cage-plate Construct: A Five-year Retrospective Cohort Study.

A retrospective cohort study. To evaluate the clinical efficacy of the self-locking stand-alone (SA) cage and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a five-year follow-up. The SA approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion. These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of SA cage is limited. We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed. In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 and 60.9 months. Both groups exhibited significant improvements in all measured values compared with the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group ( P <0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively ( P =0.365). The radiographic adjacent segment degeneration (ASD) was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P <0.01). No symptomatic ASD was observed in the SA group, and six (5.7%) cases occurred in the CPC group ( P =0.029). In this study, the SA cage showed similar efficacy to that of the conventional CPC in treating cervical spondylosis using anterior cervical discectomy and fusion, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.

A randomized controlled study of two different fixations in anterior cervical discectomy of multilevel cervical spondylotic myelopathy.

Background: To compare the efficacy of anterior cervical discectomy and hybrid fusion (ACDHF) with short-segment plate plus self-locking, stand-alone intervertebral cages versus traditional anterior cervical discectomy and fusion (ACDF) with long-segment plate for multilevel cervical spondylotic myelopathy (MCSM). Methods: All the patients were randomly divided into two groups. 30 cases underwent ACDHF with short-segment plate and self-locking stand-alone cages (hybrid group), while the other 30 cases received ACDF with long-segment plate (control group). In patients meeting the inclusion and exclusion criteria, operation time, blood loss, postoperative drainage volume, length of stay (LOS), visual analogue scale for neck pain (VASNP) scores, Japanese Orthopaedic Association (JOA) score, and the cervical lordosis before and after the operation (5 days, 3, 6, 12 months after operation and final follow-up) were evaluated. The postoperative complications were analyzed as well. Results: All operations were performed uneventfully with followed-up. Compared with ACDF, ACDHF showed a shorter operation time, less intraoperative blood loss and postoperative drainage (p < 0.05). There were no significant difference in LOS between two groups (p ˃ 0.05). Both approaches significantly improved the JOA scores, VASNP scores and the cervical lordosis (p < 0.05). Based on Bazaz grading system, hybrid group had a lower incidence of dysphagia than control group in follow-up periods of 5 days, 3 and 6 months (p < 0.05). Conclusion: ACDF and ACDHF are both effective methods of restoring cervical lordosis following MCSM, but hybrid surgery minimizes intraoperative injury and postoperative dysphagia, making it a viable treatment option for the disorder.

Zero-Profile Anchored Spacer (ROI-C) in the Treatment of Cervical Adjacent Segment Disease.

Background Self-locking stand-alone cages have increasingly been used in anterior cervical discectomy and fusion (ACDF) cervical degenerative disc disease. We studied clinical and radiological outcomes of patients who underwent zero-profile anchored spacer (ROI-C)–assisted ACDF without anterior plate fixation in cervical adjacent segment disease. Materials and Methods Fifteen patients suffering from cervical adjacent segment disease with various symptoms, such as radiculopathy, myelopathy, or both, were retrospectively evaluated. The cervical adjacent segment disease was confirmed by plain radiographs and magnetic resonance imaging. The patients underwent radiological evaluation to assess cervical curvature, intervertebral height, fusion, and subsidence. Clinical assessment was graded using a visual analog scale, Modified Japanese Orthopedic Association score, and the Neck Disability Index. Results There were 19 levels of operation. Single-level ACDF was performed in 11 patients and two level in 4 patients. In the postoperative period, our study revealed significant improvement in the clinical outcome. The cervical curvature and intervertebral height were significantly improved at 12-months follow-up ( p < 0.05). The fusion rate was 100%, whereas subsidence occurred in 5.3% but produced no symptoms. Of the 19 operated segment, 2 (5.3%) from 38 VerteBRIDGE plates had breakage. There was only one case of mild dysphagia, which resolved in less than 2 weeks. Conclusion This study indicates that zero-profile anchored spacer (ROI-C) in the treatment of cervical adjacent segment disease provides improvement of clinical outcomes, restoration of lordosis, high fusion rate, and low incidence of dysphagia. However, subsidence and breakage of VerteBRIDGE plate occurred in 5.3% cases, but did not cause clinical symptoms.

Preliminary outcomes of allograft and hydroxyapatite as substitutes for autograft in anterior cervical discectomy and fusion with self-locking standalone cages

PurposeTo investigate the efficacy and safety of allograft and hydroxyapatite (HA) as substitutes for autograft in anterior cervical discectomy and fusion (ACDF).MethodsIn this study, 49 patients (80 segments) treated with ACDF were included and allocated into three groups [group A, autogenous iliac bone, n = 18; group B, allogeneic bone, n = 16; group C, HA, n = 15]. The clinical efficacy and fusion status were compared among each group. Complications were recorded in detail, and the Bazaz classification and Voice Handicap Index-10 (VHI-10) were used to detect dysphagia and dysphonia.ResultsPatients exhibited similar clinical efficacy among the groups during the final follow-up. All patients in groups A and B achieved fusion compared to only 73.3% of patients in group C. Groups A and B had similar fusion score, both of which greater than that of group C. No cage subsidence was observed in group A; however, 6.3% of patients in group B and 53.3% in group C had cage subsidence. Two patients in group A (11.1%) had persistent pain at the donor site. One patient in group B had dysphagia and dysphonia (6.3%), while one patient in group C had dysphonia (6.7%).ConclusionIn ACDF, the autogenous iliac bone was the most ideal bone graft. The allogeneic bone was an acceptable substitute but risked cage subsidence and dysphagia. HA had a much lower fusion rate and a high risk of cage subsidence. Better substitutes should be further explored for ACDF.

Could self-locking stand-alone cage reduce adjacent-level ossification development after aneterior cervical discectomy and fusion?

Numerous studies have shown that cervical arthrodesis is associated with the adjacent-segment pathology (ASP), such as adjacent-level ossification development (ALOD). However, it still remains largely unclear whether the self-locking stand-alone implant system can reduce the incidence of ALOD. In the present study, we prospectively recruited 120 patients with cervical degenerative disc disease (CDDD) who were treated by anterior cervical discectomy and fusion (ACDF). These patients were randomly and evenly divided into the ROI-C group and plate group. Clinical and radiologic follow-up was performed at 3, 6, 12, 24 and 36 months after surgery. Clinical evaluation included preoperative and postoperative assessments of Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI) score. The presence and severity of ALOD, as well as the C2-7 Cobb angle, were assessed on the lateral cervical films during follow-up. There were no significant differences in JOA and NDI scores at each time point during the follow-up period between the two groups. ALOD occurred in 8.8% of 58 patients and 6.7% of 104 levels in the cage group. Moreover, ALOD occurred in 20.1% of 57 patients and 17.8% of 101 levels in the plate group. The ALOD was more serious in the plate group compared with the cage group. The C2-7 Cobb angle was significantly improved compared with that before the operation and could be maintained during the follow-up in both groups. The self-locking stand-alone cage was efficacious for ACDF, and it could reduce the incidence of ALOD compared with anterior plate and cage.

Cervical Intervertebral Cages: Past, Present, Innovations, and Future Trends with Review of the Literature.

Abstract Background Data: Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for degenerative conditions of the cervical spine. Since the introduction of the procedure in the fifties, ACDF has become quite popular and a gold standard procedure. Autologous iliac crest bone grafts were used for fusion with associated drawbacks that mandated the introduction of new metallic substitutes with various fillers. Many improvements and enhancements to these cages were implemented with rising controversial issues. Purpose: To review the available data of cervical cages and the recent status of ACDF using standalone cages. Study Design: A narrative literature review. Patients and Methods: We reviewed the English literature through the last two decades for the most up-to-date available data of the cervical cages and reported the current status of ACDF outcomes using standalone cages. We ran a search using PubMed, Cochrane, and Google Scholar using different relevant keywords and extracted the most relevant researches according to our study aim. We focused on special titles that we thought were most relevant to the spinal surgeon's daily practice. Results: A great number of cervical cages with different shapes and designs are available for ACDF. Spinal surgeons are confronted with a huge array of cervical cages introduced every day by many medical industry competitors. Clinical and radiological outcomes are generally very satisfactory regardless of the type and material of cages used. Composite or titanium-coated PEEK cervical cages and 3D-printed and porous titanium cages are under evaluation. Self-locking standalone cages showed great advancement and development with promising outcomes. Conclusion: ACDF is a well-established surgical technique in the management of cervical spondylotic radiculopathy and/or myelopathy. Large numbers of cervical cages with different shapes, designs, and compositions are available in the market with generally satisfactory clinical and radiological outcomes. Spinal surgeons should be aware of the available cervical cages and choose the most suitable to their patient’s medical and socioeconomic status. New industrial technology has the potential to improve the load-bearing surface, lower cage dislocation and subsidence, and osteointegration. Composite cages, self-locking cages, and absorbable cages are fairly newly introduced cages and still under evaluation. Multicenter long-term prospective randomized controlled trials are mandatory for obtaining first-class evidence-based medical data on ACDF. (2020ESJ213) Abstract Background Data: Anterior cervical discectomy and fusion (ACDF) has been the standard treatment for degenerative conditions of the cervical spine. Since the introduction of the procedure in the fifties ACDF have become quite popular and gold standard procedures. Autologous iliac crest bone grafts were used for fusion with associated drawbacks that mandates the introduction of new metallic substitutes with various fillers. Lots of improvements and enhancements of these cages were supposed with arising controversial issues. Purpose: To review the available data of cervical cages and the recent status of ACDF using standalone cages. Study Design: narrative literature review. Patients and Methods: We reviewed the English literature for the most up-to-date available data of the cervical cages and reported the current status of ACDF outcomes using standalone cages. We ran a search using PubMed, Cochrane, and Google Scholar using different relevant keywords and extracted the most relevant researches according to our study aim. We focused on special titles that we thought they are most relevant to the spinal surgeon daily practice. Results: a great number of cervical cages with different shape and designs are available for ACDF. Spinal surgeons are confronted with a huge array of cervical cages introduced every day by many medical industrial competitors. Clinical and radiological outcomes are generally very satisfactory regardless the type and material of cages used. Composite or titanium coated PEEK cervical cages are under evaluation as well as 3D print and porous titanium cages. Self-locking standalone cages showed a great advancement and development with promising outcomes. Conclusion: ACDF is a well-established surgical technique in the management of cervical spondylotic radiculopathy and/or myelopathy. Large numbers of cervical cages with different shapes, designs, and compositions are available in the market with generally satisfactory clinical and radiological outcomes. Spinal surgeons should be aware of available cervical cages and choose the most suitable to their patient’s medical and socioeconomic status. New industrial technology has the potentials of improving load-bearing surface, lower cage dislocation and subsidence, and improve osteointegration. Composite cages, self-locking cages, absorbable cages are fairly introduced cages and still under evaluation. Multicenter long-term prospective randomized controlled trials are mandatory for first class evidence based medical data in ACDF. (2020ESJ213)

Self-Locking Stand-Alone Cage Used from Opposite Approach for the Treatment of Adjacent Segment Disease After an Anterior Cervical Corpectomy and Fusion.

To investigate the efficacy and safety of the self-locking stand-alone cage used from opposite approach for the treatment of adjacent segment disease (ASD) after an anterior cervical corpectomy and fusion (ACCF). In this study, we retrospectively analyzed the clinical data of 8 cases of ACCF in the treatment of ASD cervical spondylopathy. All patients received self-locking stand-alone cage treatment. At different time points, the clinical status was evaluated using the Japan Orthopedic Association (JOA) score, JOA recovery rate (RR), and Neck Disability index (NDI) score. X-ray measurements included C2-C7 Cobb angle, fusion segment angle (FSA), cervical vertebral bow depth (VBP), and height of surgical segment (HOS). Statistical imaging parameters of sagittal cervical spine. Bone graft fusion in all self-locking stand-alone cage segments was evaluated. All operations were successfully completed, and no infection, epidural hematoma, or rupture of the dura mater were observed in all patients. Compared with pre-operation, the JOA and NDI scores at 3 months and at the last follow-up were significantly improved (p < 0.05). The JOA recovery rate between the final follow-up and preoperatively was 64.8±5.2%. One patient had dysphagia postoperatively, but was resolved after 3 months. Three months after surgery, the sagittal radiographic outcomes improved significantly and were well maintained during the final follow-up. The self-locking stand-alone cage is a reliable and effective method used from the opposite approach for the treatment of ASD after ACCF in terms of JOA and NDI scores. The cervical alignment correction is considered satisfactory.

Postoperative Outcomes and Complications after Anterior Cervical Discectomy and Interbody Fusion with a Self-locking Stand-alone Cage

Postoperative Outcomes and Complications after Anterior Cervical Discectomy and Interbody Fusion with a Self-locking Stand-alone Cage

Dynamic Fusion Process in the Anterior Cervical Discectomy and Fusion with Self-Locking Stand-Alone Cages

Self-locking stand-alone cages can achieve satisfactory clinical results and fusion rate. However, there have been no reports on the causes and relationship of different fusion state. This study is to classify the different fusion states of the index level and to explore the potential contributing factors and links of them. From June 2008 to October 2011, 42 patients underwent anterior cervical discectomy and fusion with MC+ cages. More than 5 years' follow-up was reviewed. The fusion state and the relevant clinical and radiologic records were reviewed retrospectively. At the last follow-up, the fusion proportion of type I, II, III, and IV was 11.7%, 16.9%, 26.9%, and 42.9%, respectively. The overall fusion rate was 97.4%. For all the fused types, significant improvement for the visual analog scale, Japanese Orthopaedic Association, and Neck Disability Index scores was found at the last follow-up (P<0.05). However, there were no significant differences between the 4 types (P > 0.05). For sagittal vertical axis, type IV was significantly larger than that of type I, II, and III (P < 0.05), and for range of motion, type III was significantly larger than that of type II and IV (P < 0.05). For anterior cervical discectomy and fusion with self-locking stand-alone cages, the fusion of the index level seems to be a progressive dynamic process during the mid-term follow-up, which may be influenced by the location of the cage, the aagittal vertical axis of the index level, and the global range of motion of the cervical spine. Satisfactory clinical results could be achieved by all the fused types.

Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis

This meta-analysis was conducted to evaluate the therapeutic effects in clinical and radiologic outcomes of a self-locking stand-alone cage (SSC) and cage-with-plate (CP) for multilevel anterior cervical discectomy and fusion (ACDF). A systematic search was performed for all comparative studies reported up to August 2018. Operative time, hospital stay, intraoperative blood loss, Japanese Orthopedic Association score, Neck Disability Index (NDI), cervical and segmental Cobb angle, intervertebral height, fusion rate, incidence of subsidence, dysphagia, and adjacent segment degeneration were analyzed with the RevMan 5.3.3 software. A total of 15 studies were included. There was no difference regarding preoperative or postoperative Japanese Orthopedic Association score, Neck Disability Index, segmental Cobb angle and intervertebral height, preoperative cervical Cobb angle, fusion rate, incidence of subsidence, and adjacent segment degeneration between the SSC and CP group (P > 0.05). However, the SSC group had shorter operative time (mean difference [MD],-11.35; 95% confidence interval [CI],-16.24 to-3.66) and hospital stay (MD,-0.64; 95% CI,-1.21 to-0.06), less intraoperative blood loss (MD,-13.22; 95% CI,-19.03 to-7.41) and postoperative cervical Cobb angle (MD,-0.70; 95% CI,-1.35 to-0.06), and lower incidence of dysphagia significantly (odds ratio,-0.57; 95% CI, 0.40-0.82) (P < 0.05). ACDF with SSC and CP in multilevel cervical spondylosis achieved similar clinical relief. Although CP maintained better cervical lordosis, SSC contributed to less surgical pain and fewer complications. ACDF with SSC is safe and efficient in treating multilevel cervical spondylosis.

Can Self-Locking Cages Offer the Same Clinical Outcomes as Anterior Cage-with-Plate Fixation for 3-Level Anterior Cervical Discectomy and Fusion (ACDF) in Mid-Term Follow-Up?

BackgroundSelf-locking stand-alone cages (MC+) and cage-with-pate fixation system are 2 different surgical methods used in anterior cervical discectomy and fusion (ACDF), but few systematic comparative studies comparing the 2 methods in treating multilevel cervical spondylotic myelopathy (MCSM) have been published.Material/MethodsSixty-two patients with MCSM who underwent multilevel ACDF were enrolled and completed at least a 3-year postoperative follow-up. The operative time, intra-operative blood loss, and clinical and radiological results were compared between the MC+ self-locking cages group and the cage-with-plate fixation group. Clinical parameters, including VAS for neck pain, Japanese Orthopedic Association (JOA) score, and neck disabled index (NDI), were evaluated. Surgical results according to Odom’s criteria and postoperative dysphagia status, C5 nerve root palsy, and loosening of the instrumentation were recorded. Postoperative radiological results, including fusion rates, fusion segmental Cobb’s angle (FSC), cervical lordosis, fusion segmental height (FSH), cage subsidence, and adjacent segment degeneration, were assessed.ResultsThe VAS score, JOA score, and NDI score were significantly improved in both groups. However, the patients in the cage-with-plate group were more likely to have neck pain at the last follow-up. The cervical lordosis, FSC, and FSH showed significant correction immediately after surgery. The loss of the cervical lordosis and FSH were higher in the MC+ group.ConclusionsWe found that use of MC+ cages is safe and effective in treating MCSM, but for patients who require strong postoperative stabilization and maintaining the cervical alignment better, the cage-with-plate fixation may best.

A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: Minimum 3-year assessment of radiographic and clinical outcomes

ObjectivesThe self-locking stand-alone cage has been clinically applied in treating cervical degenerative disc disease (CDDD). However, no long-term clinical and radiographic studies have been performed so far. This retrospective study was designed to analyze and compare the efficacy and outcomes of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone cages and cages with the anterior cervical plating system. Patients and methodsA total of 98 consecutive patients were recruited in this study. Patients in the cage group were given stand-alone self-locking cages, and patients in the plate group were treated with cages and anterior plate fixation. The operative time, intraoperative blood loss and complications were recorded. Clinical outcomes were evaluated using the JOA scoring system, Neck Disability Index and Odom’s criteria. The cervical lordosis, subsidence and cervical fusion status were assessed by X-ray and computed tomography. ResultsThe mean follow-up period was 39.7 months in the cage group and 42.2 months in the plate group. The operative time, intraoperative blood loss, postoperative dysphagia, sore throat and adjacent segment degeneration in the cage group were significantly less than those in the plate group (p < 0.05). All the patients in both groups achieved complete interbody fusion. Postoperative JOA and NDI scores in both groups were obviously improved compared with the preoperative ones. The postoperative cervical lordosis was effectively restored in both groups. ConclusionsThe self-locking stand-alone cage for ACDF could effectively restore the cervical physiological curvature, cause few complications, and lead to satisfactory outcomes. Therefore, it could be used as an effective and reliable treatment for the CDDD.

Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8months. The average operative time was 103±18.5min, and the average blood loss was 115±13.3mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively (P<0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.

Skip-level Anterior Cervical Discectomy and Fusion With Self-locking Stand-alone PEEK Cages for the Treatment of 2 Noncontiguous Levels of Cervical Spondylosis

Retrospectively study. To evaluate clinical and radiologic outcomes of skip-level anterior cervical discectomy and fusion (ACDF) with self-locking stand-alone polyetheretherketone (PEEK) cages for the treatment of 2 noncontiguous levels of cervical disk degenerative disease (CDDD). The use of stand-alone PEEK cages in ACDF has been proved to be safe and effective to treat CDDD. For 2 noncontiguous levels of CDDD, skip-level ACDF with self-locking stand-alone PEEK cages, which fuses only the involved levels without anterior plates, may be the optimal treatment choice. Sixteen consecutive patients with 2 noncontiguous levels of CDDD underwent skip-level ACDF with self-locking stand-alone PEEK cages. Clinical outcomes were evaluated using Japanese Orthopaedic Association scores and Odom criteria. Fusion rate and time, cages subsidence, spinal curvature, intervertebral height at the operated level, and adjacent disk degeneration were assessed. Patients were followed up for average 43.6 months (range, 24-78 mo). The mean operative time was 113 minutes (range, 98-134 min) with an average blood loss of 62 mL (range, 47-76 mL). The Japanese Orthopaedic Association score, degree of spinal curvature, and intervertebral height were significantly increased at the final follow-up examination compared with preoperatively (P<0.05). Fifteen patients (93.8%) achieved solid fusion in an average time of 5.1 months. Three cages (9.38%) in 2 patients subsided. Radiologic evidence of adjacent segment degeneration was observed in 3 segments (6.25%; 2 infra-adjacent segments and 1 intermediate segment). No case had neurological deterioration postoperatively. No implant failure or migration was observed during follow-up. Treatment of 2 noncontiguous levels of CDDD with skip-level ACDF with self-locking stand-alone cages achieved good clinical and radiologic outcomes including a high fusion rate, low complication rate, and excellent maintenance of spinal curvature and intervertebral height.