Objective:
To evaluate the results of Anterior Cervical Discectomy and Fusion by Stand-alone PEEK cage for the treatment of double level cervical spondylotic myelopathy.
Background:
Cervical spondylotic myelopathy is a common cause of neck pain and radiating arm pain which develops when one or more of the intevertebral discs in the cervical spine start to degenerate. Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for degenerative cervical spine disease.Multiple techniques and modalities of fixation are used in ACDF, among them use of Stand-alone PEEK cage is standard one. To counteract the complications with the plating for ACDF, Stand-alone cage concept was constructed and favourable outcomes have been described with a low rate of dysphagia. Stand-alone PEEK cage provides immediate load bearing support to the anterior column and may facilitate fusion.
Materials & methods:
This retrospective study was conducted in the spine unit of Orthopaedic Surgery department of Bangabandhu Sheikh Mujib Medical University, Shahbag and other private hospitals in Dhaka, Bangladesh from January 2016 to December 2021. A total number of 50 patients with cervical spondylotic myelolopathy with two level involvement confirmed by MRI were selected for the study who were failed to improve after conservative treatment. Outcome was evaluated by usingvisual analog score (VAS), Modified Odom`s criteria, Nurick’s grading and fusion rate by Bridwell’s criteria.
Results:
Mean patient age was 48.4 ± 6.49 years. Male: female ratio 2:1. Pre-operatively, mean VAS score was 7.13±1.51 whereas post-operatively VAS score was decreased significantly to 0.47±0.64 after 12 months of follow up (p value <0.001). Neurological outcome was assessed by Nurick grading system, where all patients were in grade I (80%), grade II (14%) & grade III (6%) pre-operatively. Post-operatively at 12 months follow up, maximum patients (92%) were in grade 0 (p value <0.001). Radiological fusion was assessed by Bridwell fusion criteria, fusion was found in 80% and 90% of patients after 6 and 12 months follow up. Overall improvement was assessed by modified Odom’s score; excellent improvement was seen in majority patients after 12 months of post-operative follow up (86%)
Conclusion:
ACDF by stand-alone PEEK cage is the best technique for the treatment of double level cervical spondylotic myelopathy with excellent functional outcome. This can be used with minimum risk as well excellent fusion rate.