Fixation of multiple level anterior cervical disc using cages versus cages and plating

Abstract

Background: Cervical disc herniation is a common cause of neck, upper limb, and upper back pain. In severe cases, neurological deficit might occur. It is surgically treated anteriorly or posteriorly, anteriorly through both cervical discectomy and fusion (ACDF) using cages alone or using cages plus plating. Objectives: We aimed to evaluate the fusion rate and the clinical outcome of multiple level anterior cervical discectomy followed by cage fusion alone and cage fusion with plate insertion. Materials and methods: In this prospective comparative study, 33 patients were included. Patients were divided into 2 groups: group A: 19 cases received ACDF and group B: 14 patients had ACDF plus plate fixation. Fusion rate was assessed by radiographs. Clinical outcome was assessed by the visual analog scale (VAS). Overall patients' satisfaction postoperatively was graded according to Odom's criteria. Results: The rate of fusion was 78.9% of patients in group A and 85.7% of patients in group B. Clinical outcomes were similar in both groups. Patient satisfaction according to Odom's criteria of outcome grading showed 36.8% of patients had excellent recovery and 31.6% had good recovery in group A. While in group B, 42.9% of patients had excellent recovery and 21.4% had good recovery. The differences between both groups were not statistically significant (P = 0.19). Conclusions: ACDF with or without plate fixation in more than two-level cervical discectomies achieves good stability and functional outcome. Addition of anterior cervical plate fixation resulted in a higher fusion rate and reduced cage subsidence than that of cage alone.

Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study

“…10,27 However, in their comparative investigation, Elsayed and Sakr concluded that the addition of anterior cervical plate may provide higher chances for fusion, along with lower risk of cage subsidence. 28 There was no residual mobility in every nonfused segment in our cohort of patients; thus, nonfusion seems not to correspond to segmental instability. Even if in our series no cases of subsidence were recorded, a lower incidence of subsidence in ACDF with plating was previously reported.…”

Analyzing results of cervical sagittal parameters in patients operated with polyetheretherketone cages without plate

“…[ 23 ] According to some studies, there are no significant differences in postoperative results when using stand-alone PEEK cages in comparison with PEEK cages + anterior plate, while others claim that using an anterior plate provides better sagittal measurements than stand-alone cages, although this does not relate to clinical results. [ 24 ] Complications may occur with any technique used. [ 2 3 4 8 11 14 25 26 ] Dysphagia due to anterior cervical plate placement may be reduced when the plate is not placed, which is also the case in adjacent segment disease.…”

“…Migration of the screws with anterior cervical plate is another important complication that can be discarded when using stand-alone cages. [ 23 24 29 ]…”