A Comparison between Standalone Cage and Conventional Cage and Plate in Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Spondylotic Myelopathy: An Ambispective Study

Document Type : Original Article

Authors

1 Assistant Professor ( Neurosurgery ) Govt Medical College,Thiruvananthapuram Kerala India

2 Senior Resident Department of Neurosurgery Govt Medical College,Thiruvananthapuram Kerala - 695011 India

3 Department of Neurosurgery Govt Medical College,Thiruvananthapuram Kerala -695011 India

4 Department of Neurosurgery Govt Medical College,Thiruvananthapuram Kerala - 695011 India

5 Professor and Head Department of Neurosurgery Govt Medical College,Thiruvananthapuram Kerala -695011 India

6 Dept of Neurosurgey Govt Medical College,Thiruvananthapuram Kerala 695011 India

7 Dept of Neurosurgery Govt Medical College,Thiruvananthapuram Kerala 695011 India

Abstract

Background Data: Anterior cervical discectomy and fusion (ACDF) is accepted as a standard surgical treatment for cervical spondylotic myelopathy (CSM). The options for instrumentation in fusion include standalone cage (SC) and conventional cage and plate (CCP). However, there is no clear consensus regarding the superiority of the technique.
Purpose: To compare the radiologic and clinical outcomes between SC and CCP in ACDF for the treatment of CSM.
Study Design: Ambispective clinical case study.
Patients and Methods: The patients who underwent ACDF for CSM using SC or CCP between January 2014 and December 2018 were included in the study. Forty-six patients out of 230 eligible patients were included in the study. Twenty-six patients underwent CCP, while 20 underwent SC. They were subjected to detailed neurologic and radiologic examination. Neurologic outcome was measured using the Nurick and mJOA scores and dysphagia using the Bazaz score. Fusion was assessed by the presence of bridging trabeculae and absence of movement between the spinous processes of the fused segments with lordosis by Cobbs’ angle. We also reported cage subsidence, adjacent segment degeneration (ASD), and implant complications.
Results: Mean follow-up was for four years. The most common level operated was C5/C6. Neurologic status improved significantly in both groups following surgery. The rate of dysphagia was not different between the groups. Fusion was achieved in 92.3% of the CCP group and 90% of the SC group (p > 0.05). The rate of subsidence was higher in the SC group (p = .026). ASD changes were present in 57% of the CCP group and 80% of the SC group at final follow-up but were insignificant. In both groups, improved cervical and segmental lordosis were reported, and although the improvement was greater in the CCP group, it was insignificant.
Conclusion: ACDF using both standalone and conventional cages and plates achieved comparable neurologic improvement in CSM. Even though both had comparable fusion rates, cage subsidence was high with standalone cages. (2021ESJ245)

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