- Visibility 90 Views
- Downloads 73 Downloads
- Permissions
- DOI 10.18231/pjms.v.15.i.2.359-363
-
CrossMark
Anterior cervical discectomy & fusion using only cage: An institutional experiences
- Author Details:
-
Poonia Nemi Chand
-
Surendra Jain *
-
Hardika Poonia
Poonia Nemi Chand
Background: Anterior Cervical Discectomy and Fusion (ACDF) using a standalone cage represents a pivotal advancement in the surgical management of cervical degenerative disc disease. This study evaluates the efficacy, safety, and clinical outcomes of ACDF performed with a standalone cage without using plate, aiming to substantiate its utility in clinical practice.
Materials and Methods: A retrospective analysis of 440 patients who underwent ACDF with a standalone cage from 2013 to 2023 was conducted at Neuro Care Hospital and Research Centre in Jaipur, India. Clinical outcomes were assessed using the Nurick grade, Visual Analog Scale (VAS) for neck and arm pain, and the Modified Japanese Orthopedic Association (mJOA) scoring system at the 6-month follow-up. Complications were also recorded.
Results: Significant improvements were observed postoperatively: Nurick grade improved from 1.46 ± 0.90 to 0.40 ± 0.59 (p<0.001), neck VAS scores from 4.04 ± 0.77 to 1.66 ± 0.93, and arm VAS scores from 7.25 ± 1.19 to 1.63 ± 0.86 (both p<0.001). The mJOA score enhanced from 11.6 ± 1.42 to 15.9 ± 1.76 (p<0.001). Complication rates were low, with cage subsidence being the most notable.
Conclusion: ACDF with a standalone cage is effective and safe, significantly improving patient outcomes at 6 months post-surgery with minimal complications, thereby supporting its application as a standard procedure for cervical degenerative disc disease.
References
- Mu G, Chen H, Fu H, Wang S, Lu H, Yi X, et al. Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study. Front Surg. 2022;9:1002744.
- Elsayed A, Sakr S. Fixation of multiple level anterior cervical disc using cages versus cages and plating. Egypt J Neurol Psychiatry Neurosurg. 2019;55:6.
- Jain PK, Malagi S, Shastry A, Hegde P, Devamane DR. Anterior cervical microdiscectomy and fusion using stand-alone Polyetheretherketone Cage: A retrospective study. J Clin Diagn Res. 2021;15(9):23–5.
- Eghbal K, Ahrari I, Kamrani F, Mohamamdi S, Saffarian A, Jamali M, et al. Multilevel anterior cervical fusion with standalone cage or cage-and-plate after cervical discectomy: Benefits and drawbacks. Asian J Surg. 2023;46:3760–5.
- Chen X, Sial A, Stewart C, Vargas Castillo J, Diwan AD. Stand- alone anterior cervical decompression and fusion surgery: A cohort study evaluating a shaped cage without plates or screws. Front Surg. 2022;9:934018.
- Panchal RR, Kim KD, Eastlack R, Lopez J, Clavenna A, Brooks DM, et al. A clinical comparison of anterior cervical plates versus stand-alone intervertebral fusion devices for single-level anterior cervical discectomy and fusion procedures. World Neurosurg. 2019;99:630–7.
- Bisson EF, Samuelson MM, Apfelbaum RI. Intermediate segment degeneration after noncontiguous anterior cervical fusion. Acta Neurochir (Wein) 2011;153:123–7.
- Pimenta L, McAfee PC, Cappuccino A, Cunningham BW, Diaz R, Coutinho E. Superiority of multilevel cervical arthroplasty outcomes versus single-level outcomes: 229 consecutive PCM prostheses. Spine (Phila Pa 1976). 2007;32(12):1337–44
- Swank ML, Lowery GL, Bhat AL, McDonough RF. Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction. Eur Spine J. 1997;6(2):138–43.
- Lowery GL, McDonough RF. The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow- up. Spine (Phila Pa 1976). 1998;23(2):181–6.
- Park MS, Ju YS, Moon SH, Kim TH, Oh JK, Makhni MC, et al. Reoperation rates after anterior cervical discectomy and fusion for cervical spondylotic radiculopathy and myelopathy. A national population-based study. Spine (Phila Pa 1976). 2016;41(20):1593–
- Burkhardt BW, Brielmaier M, Schwerdtfeger K, Sharif S, Oertel JM. Smith-Robinson procedure with an autologous iliac crest graft and caspar plating: report of 65 patients with an average follow-up of 22 years. World Neurosurg. 2016;90:244–50.
- Geisler FH, Caspar W, Pitzen T, et al. Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine (Phila Pa 1976). 1998;23(80:911–20.
- Song KJ, Yoon SJ, Lee KB. Three- and four-level anterior cervical discectomy and fusion with a PEEK cage and plate construct. Eur Spine J. 2012;21(12):2492–7.
- Chen Y, Lü G, Wang B, Li L, Kuang L. A comparison of anterior cervical discectomyand fusion (ACDF) using self-locking stand- alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatmentof three-level cervical degenerative spondylopathy: a retrospective study with2-year follow-up. Eur Spine J. 2020; 25(7):2255e–62.
- Cheung ZB, Gidumal S, White S, Shin J, Phan K, Osman N, et al. Comparison of anterior cervical discectomy and fusion with a stand- alone interbody cage versus a conventional cage-plate technique: a systematic review and meta-analysis. Global Spine J. 2019;9(4):446e–55.
- Ahn, CH, Kang, S, Cho, M, Kim SH, Kim CH, Han I, et al. Comparing zero-profile and conventional cage and plate in anterior cervical discectomy and fusion using finite-element modeling. Sci Rep. 2023;13:15766.
- Purohit DK, Seervi M, Jain S, Meena US. Evalution of radiological and neurological outcomes after anterior cervical corpectomy with fusion using expandable cage alone and expandable cage with anterior cervical plating. AJNS. 2023;18(1):91–100.
- Wang B, Lü G, Kuang L. Anterior cervical discectomy and fusion with stand-alone anchored cages versus posterior laminectomy and fusion for four-level cervical spondylotic myelopathy: a retrospective study with 2-year follow-up. BMC Musculoskelet Disord. 2018;19(1):216.