Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

A Prospective Study with Cage-Only or Cage-with-Plate Fixation in Anterior Cervical Discectomy and Interbody Fusion of One and Two Levels

  • Kim, Sam Yeol (Department of Neurosurgery, Inha University School of Medicine) ;
  • Yoon, Seung Hwan (Department of Neurosurgery, Inha University School of Medicine) ;
  • Kim, Dokeun (Department of Neurosurgery, Inha University School of Medicine) ;
  • Oh, Chang Hyun (Guri Cham Teun Teun Hospital) ;
  • Oh, Seyang (Department of Neurosurgery, Inha University School of Medicine)
  • Received : 2017.07.10
  • Accepted : 2017.08.30
  • Published : 2017.11.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The authors prospectively analyzed the effect of one-level or two-level anterior cervical discectomy and fusion (ACDF), comparing stand-alone cages and cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes. Methods : A total of 84 patients who underwent one-level (n=52) or two-level ACDF (n=32) for cervical disc disease and who completed 2 years of follow-up were included in this study. The patients were divided by cervical level and grouped into ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using radiographs : subsidence, C2-C7 lordosis angle, fusion segment angle, adjacent disc space narrowing, and fusion status. Clinical outcomes were assessed using the neck disability index (NDI) and visual analog scale scores for arm pain. Results : In the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, the NDI score was better in the cage-only group at the 3-, 12-, and 24-month follow-ups : however, no significant difference in clinical outcomes was observed. In the comparison of two-level ACDF-cage-only and ACDF-cage-with-plate groups, no difference in any clinical outcome was observed between the two groups. At the 24-month follow-up, subsidence was observed in 45.8% of patients in the one-level cage-only group and 32.1% of patients in the one-level cage-with-plate fixation group. There was no statistically significant difference in the incidence rate between the two groups (p=0.312). Subsidence in the two-level cage-only group (66.6%) was significantly more frequent than in the two-level cage-with-plate fixation group (30%; p=0.049). The fusion rate for patients in the one-level cage-only group was not significantly different from that in the one-level cage-with-plate fixation group (cage-only, 87.5%; cage-with-plate fixation, 92.9%; p=0.425) ; fusion rate in the two-level patients were also similar between groups (cage-only, 83.3%; cage-with-plate fixation, 95%; p=0.31). Conclusion : Our clinical results showed that for single-level cases, plate fixation had no additional benefit versus cage-only; for two-level ACDF cases, the fusion rate and clinical outcomes were similar, although the cage-with-plate fixation group had a lower incidence of cage subsidence than did the cage-only group. We conclude that physicians should be aware of this possible disadvantage associated with using cervical plates in one-level ACDF. However, in two-level ACDF, subsidence is more likely to occur without plate fixation, and thus the addition of plate fixation should be considered.

Keywords

References

  1. Ahn SS, Paik HK, Chin DK, Kim SH, Kim DW, Ku MG : The fate of adjacent segments after anterior cervical discectomy and fusion: the influence of an anterior plate system. World Neurosurg 89 : 42-50, 2016 https://doi.org/10.1016/j.wneu.2016.01.013
  2. Cho DY, Lee WY, Sheu PC : Treatment of multilevel cervical fusion with cages. Surg Neurol 62 : 378-385; discussion 385-6, 2004 https://doi.org/10.1016/j.surneu.2004.01.021
  3. Choi MK, Kim SB, Park CK, Kim SM : Comparison of the clinical and radiologic outcomes obtained with single- versus two-level anterior cervical decompression and fusion using stand-alone PEEK cages filled with allograft. Acta Neurochir (Wien) 158 : 481-487, 2016 https://doi.org/10.1007/s00701-015-2692-1
  4. Demircan MN, Kutlay AM, Colak A, Kaya S, Tekin T, Kibici K, et al. : Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft. J Clin Neurosci 14 : 723-728, 2007 https://doi.org/10.1016/j.jocn.2006.02.026
  5. El-Tantawy A : Is it possible to eliminate the plate-related problems and still achieve satisfactory outcome after multilevel anterior cervical discectomy? Eur J Orthop Surg Traumatol 25(Suppl 1) : 135-145, 2015
  6. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. : Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32 : 2310-2317, 2007 https://doi.org/10.1097/BRS.0b013e318154c57e
  7. Fraser JF, Hartl R : Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6 : 298-303, 2007 https://doi.org/10.3171/spi.2007.6.4.2
  8. Han SY, Kim HW, Lee CY, Kim HR, Park DH : Stand-alone cages for anterior cervical fusion: are there no problems? Korean J Spine 13 : 13-19, 2016 https://doi.org/10.14245/kjs.2016.13.1.13
  9. Hilibrand AS, Robbins M : Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4(6 Suppl) : 190S-194S, 2004 https://doi.org/10.1016/j.spinee.2004.07.007
  10. Jacobs W, Willems PC, Kruyt M, van Limbeek J, Anderson PG, Pavlov P, et al. : Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976) 36 : E950-E960, 2011 https://doi.org/10.1097/BRS.0b013e31821cbba5
  11. Ji GY, Oh CH, Shin DA, Ha Y, Kim KN, Yoon DH, et al. : Stand-alone cervical cages versus anterior cervical plates in 2-level cervical anterior interbody fusion patients: analysis of adjacent segment degeneration. J Spinal Disord Tech 28 : E433-E438, 2015 https://doi.org/10.1097/BSD.0b013e3182a355ad
  12. Joo YH, Lee JW, Kwon KY, Rhee JJ, Lee HK : Comparison of fusion with cage alone and plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc 48 : 342-346, 2010 https://doi.org/10.3340/jkns.2010.48.4.342
  13. Kast E, Derakhshani S, Bothmann M, Oberle J : Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 32 : 207-214; discussion 214, 2009 https://doi.org/10.1007/s10143-008-0168-y
  14. Kim MK, Kim SM, Jeon KM, Kim TS : Radiographic comparison of four anterior fusion methods in two level cervical disc diseases: autograft plate fixation versus cage plate fixation versus stand-alone cage fusion versus corpectomy and plate fixation. J Korean Neurosurg Soc 51 : 135-40, 2012 https://doi.org/10.3340/jkns.2012.51.3.135
  15. Lee CH, Hyun SJ, Kim MJ, Yeom JS, Kim WH, Kim KJ, et al. : Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech 26 : 112-118, 2013 https://doi.org/10.1097/BSD.0b013e318274148e
  16. Lee YS, Kim YB, Park SW : Risk factors for postoperative subsidence of single-level anterior cervical discectomy and fusion: the significance of the preoperative cervical alignment. Spine (Phila Pa 1976) 39 : 1280-1287, 2014 https://doi.org/10.1097/BRS.0000000000000400
  17. Li J, Li Y, Kong F, Zhang D, Zhang Y, Shen Y : Adjacent segment degeneration after single -level anterior cervical decompression and fusion: disc space distraction and its impact on clinical outcomes. J Clin Neurosci 22 : 566-569, 2015 https://doi.org/10.1016/j.jocn.2014.08.019
  18. Litrico S, Lonjon N, Riouallon G, Cogniet A, Launay O, Beaurain J, et al. : Adjacent segment disease after anterior cervical interbody fusion: a multicenter retrospective study of 288 patients with long-term follow-up. Orthop Traumatol Surg Res 100 (6 Suppl) : S305-S309, 2014 https://doi.org/10.1016/j.otsr.2014.07.004
  19. Nambiar M, Phan K, Cunningham JE, Yang Y, Turner PL, Mobbs R : Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease: a systematic review and metaanalysis. Eur Spine J 26 : 2258-2266, 2017 https://doi.org/10.1007/s00586-017-5015-9
  20. Oh JK, Kim TY, Lee HS, You NK, Choi GH, Yi S, et al. : Stand-alone cervical cages versus anterior cervical plate in 2-level cervical anterior interbody fusion patients: clinical outcomes and radiologic changes. J Spinal Disord Tech 26 : 415-420, 2013 https://doi.org/10.1097/BSD.0b013e31824c7d22
  21. Oh K, Lee CK, You NK, Kim SH, Cho KH : Radiologic changes of anterior cervical discectomy and fusion using allograft and plate augmentation: comparison of using fixed and variable type screw. Korean J Spine 10 : 160-164, 2013 https://doi.org/10.14245/kjs.2013.10.3.160
  22. Park SB, Chung CK, Lee SH, Yang HJ, Son YJ, Chung YS : The impact of menopause on bone fusion after the single-level anterior cervical discectomy and fusion. J Korean Neurosurg Soc 54 : 496-500, 2013 https://doi.org/10.3340/jkns.2013.54.6.496
  23. Pereira EA, Chari A, Hempenstall J, Leach JC, Chandran H, Cadoux-Hudson TA : Anterior cervical discectomy plus intervertebral polyetheretherketone cage fusion over three and four levels without plating is safe and effective long-term. J Clin Neurosci 20 : 1250-1255, 2013 https://doi.org/10.1016/j.jocn.2012.10.028
  24. Resnick DK, Trost GR : Use of ventral plates for cervical arthrodesis. Neurosurgery 60(1 Suppl 1) : S112-S117, 2007
  25. Shiban E, Gapon K, Wostrack M, Meyer B, Lehmberg J : Clinical and radiologic outcome after anterior cervical discectomy and fusion with stand-alone empty polyetheretherketone (PEEK) cages. Acta Neurochir (Wien) 158 : 349-355, 2016 https://doi.org/10.1007/s00701-015-2630-2
  26. Singh P, Kumar A, Shekhawat V : Comparative analysis of interbody cages versus tricortical graft with anterior plate fixation for anterior cervical discectomy and fusion in degenerative cervical disc disease. J Clin Diagn Res 10 : RC05-RC08, 2016
  27. Song KJ, Choi BW, Kim JK : Adjacent segment pathology following anterior decompression and fusion using cage and plate for the treatment of degenerative cervical spinal diseases. Asian Spine J 8 : 720-728, 2014 https://doi.org/10.4184/asj.2014.8.6.720
  28. Song KJ, Taghavi CE, Lee KB, Song JK, Eun JP : The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34 : 2886-2892, 2009 https://doi.org/10.1097/BRS.0b013e3181b64f2c
  29. Wang JC, McDonough PW, Endow KK, Delamarter RB : Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 25 : 41-45, 2000 https://doi.org/10.1097/00007632-200001010-00009

Cited by

  1. Comparison of the outcomes of cage-stand-alone with cage-with-plate fixation in one level and two levels for treating cervical disk diseases vol.9, pp.3, 2017, https://doi.org/10.4103/jcvjs.jcvjs_74_18
  2. Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis vol.28, pp.1, 2019, https://doi.org/10.1007/s00586-018-5811-x
  3. Stand-Alone Cervical Cages in 2-Level Anterior Interbody Fusion in Cervical Spondylotic Myelopathy: Results from a Minimum 2-Year Follow-up vol.13, pp.2, 2017, https://doi.org/10.31616/asj.2018.0193
  4. Subsidence after Anterior Cervical Interbody Fusion Using a Zero-Profile Device vol.5, pp.2, 2019, https://doi.org/10.21129/nerve.2019.5.2.33
  5. Anterior cervical discectomy and fusion: Techniques, complications, and future directives vol.32, pp.1, 2017, https://doi.org/10.1016/j.semss.2019.100772
  6. Comparison of stand-alone cage and cage-with-plate for monosegmental cervical fusion and impact of virtual reality in evaluating surgical results vol.191, pp.None, 2017, https://doi.org/10.1016/j.clineuro.2020.105685
  7. Long-term Outcome Following Three-Level Stand-Alone Anterior Cervical Discectomy and Fusion: Is Plating Necessary? vol.15, pp.3, 2017, https://doi.org/10.4103/ajns.ajns_196_19
  8. Bioactive Glass-Ceramic (NOVOMAX®) Spacer for Anterior Cervical Discectomy and Fusion: A Minimum 2-Year Follow-Up Study vol.6, pp.2, 2017, https://doi.org/10.21129/nerve.2020.6.2.57
  9. Comparative Study of Various Cages in Posterior Lumbar Interbody Fusion of the Lower Lumbar Spine vol.28, pp.2, 2021, https://doi.org/10.4184/jkss.2021.28.2.49
  10. The outcomes of stand alone polyetheretherketone cages in anterior cervical discectomy and fusion vol.45, pp.1, 2017, https://doi.org/10.1007/s00264-020-04760-1
  11. Adjacent-Level Ossification Development in Single-Level Standalone Anterior Cervical Discectomy and Fusion Versus Anterior Cervical Discectomy and Fusion With Plate vol.11, pp.3, 2017, https://doi.org/10.1177/2192568220902749