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Long-term Outcome Following Three-Level Stand-Alone Anterior Cervical Discectomy and Fusion: Is Plating Necessary?
Marios Theologou1,2, Theologos Theologou3, Nikolaos Skoulios1
1Second Departments of Neurosurgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece.
Asian Journal of Neurosurgery
|November 4, 2020
Summary
This study found that three-level anterior cervical discectomy with fusion (ACDF) without anterior plating is safe and effective. Patients experienced significant improvements in pain and disability, with high fusion rates and minimal complications.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Fusion Techniques
Background:
- Anterior cervical discectomy with fusion (ACDF) is a standard treatment for cervical spine conditions.
- The necessity of anterior plating in multilevel ACDF remains a subject of debate.
- This study evaluates fusion rates and long-term outcomes of three-level ACDF without anterior plating.
Purpose of the Study:
- To assess the fusion rates (FRs) and clinical outcomes of three-level ACDF performed without anterior plating.
- To determine the safety and efficacy of multilevel stand-alone ACDF.
- To evaluate the incidence and clinical significance of subsidence.
Main Methods:
- Retrospective analysis of patient records undergoing three-level ACDF for degenerative cervical disease.
- Utilized polyether ether-ketone (PEEK) cages without anterior plating.
- Assessed outcomes using Visual Analog Scale (VAS) for pain, Neck Disability Index (NDI), and plain radiographs.
- Defined fusion by <1 mm interspinous motion and subsidence by >2 mm interbody height decrease.
Main Results:
- Postoperative NDI indicated no disability, and VAS scores showed absence of neck and arm pain.
- Mean fusion rate was 19.50 ± 21.71 levels per month, peaking between 3-6 months.
- Subsidence occurred in 15.38% of patients, most commonly at C6-7, but was generally clinically insignificant.
- Transient dysphagia was reported in 1.28% of patients.
Conclusions:
- Multilevel stand-alone ACDF is a safe and cost-effective procedure.
- Favorable clinical and radiological results are achievable with this technique.
- Careful surgical technique can minimize the incidence of clinically insignificant subsidence.
