Comparative study of anterior cervical discectomy and fusion by anterior cervical plate and stand-alone cervical cage
Keywords:DCDD, ACD, ACDF-SAC, ACDF-ACP, Robinson’s criteria, Cobb’s angle
Background: Anterior cervical discectomy (ACD) was used for management of degenerative cervical disc disorders (DCDD) in previous days. Further research and developments in management of DCDD led to evolution of standard and widely used operative technique as anterior cervical discectomy and fusion (ACDF) by either anterior cervical plate (ACDF-ACP) with bone grafting or stand-alone cage (ACDF-SAC). There is less data available in literature regarding when and where to use ACDF-ACP and ACDF-SAC.
Methods: The study was conducted on 20 patients operated in Government Medical College and Hospital and Pacific Hospital and Research Centre, Aurangabad from June 2018 to March 2020. These patients divided into group A - 10 patients, operated by ACDF-SAC which are further divided as group Aa - 6 patients - operated for single level ACDF-SAC and group Ab - 4 patients - operated for two level ACDF-SAC, group B - 10 patients, operated by ACDF-ACP which are further divided as group Ba - 5 patients - operated for single level ACDF-ACP and group Bb - 5 patients - operated for two level ACDF-ACP. Patients evaluated preoperatively and postoperatively using X-ray cervical spine anteroposterior (AP) and lateral views, MRI cervical spine, visual analogue scale (VAS) for pain, Robinson’s criteria and Cobb’s angle.
Results: In our study we found, ACDF-SAC has small incision size, less intraoperative time, easy to carry out for surgeons, less intraoperative complications and better clinical outcome as compared to ACDF-ACP. Whereas only radiological results were better in ACDF-ACP than ACDF-SAC.
Conclusions: ACDF-SAC is superior to ACDF-ACP for appropriately selected patients and in well experienced hands.
Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15:602-17.
Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine. Phila Pa. 1976;9:667-71.
Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40:607-24.
Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223- 4.
Korinth MC. Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir. 2008;69:113-24.
Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary R, et al. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine. 2009;11:183-97.
Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine. 2009;11:130-41.
Campbell’s Operative Orthopaedics. Twelfth edition. 1919-1923.
Angevine PD, Arons RR, Mccormick PC. National and regional rates and variation of cervical discectomy with and without anterior fusion. Spine. 2003;28:931-9.
Jacobs WC, Anderson PG, Limbeek J. Single or double level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Systematic Reviews. 2011;1:CD004958.
Fraser JF, Hartl R. Anterior approaches to fusion of the cervical spine: a meta-analysis of fusion rates. J Neurosurg Spine. 2007;6:298-303.
Ha BY, Sim HB, Lyo IU, Park ES, Kwon SC, Park JB. Comparisons of Two-level Discectomy and Fusion with Cage Alone versus Single-level Corpectomy and Fusion with Plate in the Treatment of Cervical Degenerative Disc Disease. Korean J Spine. 2012;9(3):197-204.
Yoo M, Kim WH, Hyun SJ, Kim KJ, Jahng TA, Kim HJ. Comparison between Two Different Cervical Interbody Fusion Cages in One Level Stand-alone ACDF: Carbon Fiber Composite Frame Cage Versus Polyetheretherketone Cage. Korean J Spine. 2014;11(3):127-35.
Aronson N, David L. Filtzer and Merwyn Bagan. Anterior Cervical Fusion by the Smith-Robinson Approach. J. Neurosurg. 1968;28:397-404.
Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR, et al. Validation of Digital Visual Analog Scale Pain Scoring with a Traditional Paper-based Visual Analog Scale in Adults. JAAOS Glob Res Rev. 2018;2:e088.
Elfering MHA. Pain assessment. Eur Spine J. 2006;15:17-24.
Lee CK, Shin DA, Yi S, Kim KN, Shin HC, Yoon DH, et al. Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament. J Neurosurg Spine. 2016;24:100-7.
Cheung JPY, Luk KDK. Complications of Anterior and Posterior Cervical Spine Surgery. Asian Spine J. 2016;10(2):385-400.
Pitzen TR, Chrobok J, Stulik J, Ruffing S, Drum J, Sova L, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two years result of a multicentric, randomized, controlled study. Spine. 2009;34:641-6.
Niu CC, Liao JC, Chen WJ, Chen LH. Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech. 2010;23:310-6.
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32:2310-7.
Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F. A new zero- profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res. 2011;469:666-73.
Scholz M, Reyes PM, Schleicher P, Sawa AGU, Baek S, Kandziora F, et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine. 2009;34:156-60.
Assietti R, Beretta F, Arienta C. Two-level anterior cervical discectomy and cage-assisted fusion without plates. Neurosurg Focus. 2002;15;12:3.
Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine. 2000;25:2646-54.
Xie JC, Hurlbert RJ. Discectomy versus discectomy with fusion versus discectomy with fusion and instrumentation: a prospective randomized study. Neurosurgery. 2007;631(1):107-16.
Baz EAE, Sultan AM, Barakat AS, Koptan W, Miligui YE, Shaker H. The use of anterior cervical interbody spacer with integrated fixation screws for management of cervical disc disease. SICOT-J. 2019;5:8.
Suchomel P, Barsa P, Buchvald P, Svobodnik A, Vanickova E. Autologus versus allogenic bone grafts in instrumented anterior cervical discectomy and fusion: a prospective study with respect to bone union pattern. Eur Spine J. 2004;13:510-5.
Bohlman HH. Surgical management of cervical spine fractures and dislocations. Instr Course Lect. 1985;34:163-87.
Zeidman SM, Ducker TB, Raycroft J. Trends and complications in cervical spine surgery: 1989-1993. J Spinal Disord. 1997;10:523-6.
Lowery GL, McDonough RF. The significance of hardware failure in anterior cervical plate fixation. Patients with 2 to 7 years follow-up. Spine. 1998;23:181-6.
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. 2010;48:342-6.
Goffin J, Loon VJ, Calenbergh VF, Plets C. Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord. 1995;8:500-8.
Barakat Y, Rashad A, Ragab M, Elrahman MIA. Comparative study between single-level anterior cervical discectomy and fusion using cage and plate or cage alone. Egyptian J Hospital Med. 2019;74(4):867-72.
Kilburg C, Sullivan HG, Mathiason MA. Effect of approach side during anterior cervical discectomy and fusion on the incidence of RLN injury. J Neurosurg Spine. 2006;4:273-7.
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. 2013;26:8.