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Published on: September 16, 2022
"Standalone Cage With Integrated Screw Fixation Versus Cage-Plate Fixation in Unilateral Cervical Facet
Anil Kumar1, Bhaskar Sarkar, Aman Verma
1Department of Orthopedics, All India Institute of Medical Sciences, Rishikesh, India.
Study Design:
Retrospective cohort study.
Objective:
To compare outcomes of stand-alone cages versus cage-plate fixation in unilateral cervical facet dislocations (UCFDs).
Summary Of Background Data:
Unilateral cervical facet dislocations are unstable spinal injuries that require timely surgical stabilization. While conventional anterior cervical discectomy and fusion with plate fixation offers strong stability, it carries risks such as dysphagia and longer operative time. Stand-alone cages with integrated locking screws have emerged as a less invasive alternative, but direct comparative evidence in UCFDs remains limited.
Methods:
Thirty patients with post-traumatic single-level UCFDs underwent anterior cervical discectomy and fusion between 2022 and 2024 using either a standalone cage with integrated screw fixation (n=12) or a cage-plate construct (n=18). Primary outcomes included fusion at 12 months, pain relief (VAS), and functional recovery (NDI). Secondary measures were operative time, intraoperative blood loss, and complications. Statistical comparisons were performed using t tests and χ2 analysis (P<0.05).
Results:
Baseline demographics and injury levels were comparable between groups (P>0.05). Plate fixation achieved greater kyphosis correction (9.77±0.39 vs. 5.40±0.50 degrees; P<0.001) but required longer operative time (95.61±3.07 vs. 66.42±4.60 min; P<0.001) and higher blood loss (119.33±5.21 vs. 55.92±10.83 mL; P<0.001). Fusion rates were not significantly different (83.3% vs. 94.4%; P=0.347), as were VAS and NDI improvements. Dysphagia occurred in 2 cage-plate cases; 1 stand-alone with integrated screw fixation had cage subsidence (P=0.241).
Conclusion:
Both approaches provided comparable fusion and pain relief. While plating enhanced kyphosis correction, Stand-alone cages with integrated screw fixation offered a lower-morbidity alternative in carefully selected UCFD patients. Given the rarity of UCFDs, this study contributes comparative evidence supporting stand-alone cages with integrated screw fixation as a lower-morbidity alternative in appropriately selected cases. Larger prospective studies are warranted to validate these findings.
Level Of Evidence:
Level III.
