Long-term Outcome Following Three-Level Stand-Alone Anterior Cervical Discectomy and Fusion: Is Plating Necessary?
Anterior cervical discectomy
fusion
outcome
stand alone
Journal
Asian journal of neurosurgery
ISSN: 1793-5482
Titre abrégé: Asian J Neurosurg
Pays: India
ID NLM: 101564712
Informations de publication
Date de publication:
Historique:
received:
25
06
2019
revised:
21
12
2019
accepted:
08
04
2020
entrez:
4
11
2020
pubmed:
5
11
2020
medline:
5
11
2020
Statut:
epublish
Résumé
Anterior cervical discectomy with fusion (ACDF) is a proven method for the treatment of selected patients. The necessity of use of an anterior plate is controversial. The article aims to assess the fusion rates (FRs) and long-term outcomes following three-level ACDF. Data were collected from the medical records of patients operated on due to degenerative cervical disease. All patients were treated with three-level ACDF employing polyether ether-ketone cages without anterior plating. Visual analog scale (VAS), neck disability index (NDI), and plain radiographs were used in the clinical and radiological postsurgery assessment. Fusion evaluation was performed according to the <1 mm motion between spinous processes rule. Subsidence was defined as a more than 2 mm decrease in the interbody height. A total of 234 treated levels on 78 patients were assessed. The mean presurgery NDI score was 23.07 ± 4.86, with a mean disability of 46.03% ± 9.64. The mean presurgery VAS score of the neck was 7.58 ± 0.85, while VAS score of the arm was 7.75 ± 1.008. Post surgery, NDI stated no disability, while VAS score of the neck and arm showed no presence of pain. The mean FR was 19.50 ± 21.71 levels per month, with a peak from 3 Multilevel stand-alone ACDF is a safe, cost-effective procedure providing favorable clinical and radiological results with minimal complications. The incidence of subsidence is usually clinically insignificant and can be decreased with a careful surgical technique.
Sections du résumé
BACKGROUND
BACKGROUND
Anterior cervical discectomy with fusion (ACDF) is a proven method for the treatment of selected patients. The necessity of use of an anterior plate is controversial. The article aims to assess the fusion rates (FRs) and long-term outcomes following three-level ACDF.
MATERIALS AND METHODS
METHODS
Data were collected from the medical records of patients operated on due to degenerative cervical disease. All patients were treated with three-level ACDF employing polyether ether-ketone cages without anterior plating. Visual analog scale (VAS), neck disability index (NDI), and plain radiographs were used in the clinical and radiological postsurgery assessment. Fusion evaluation was performed according to the <1 mm motion between spinous processes rule. Subsidence was defined as a more than 2 mm decrease in the interbody height.
RESULTS
RESULTS
A total of 234 treated levels on 78 patients were assessed. The mean presurgery NDI score was 23.07 ± 4.86, with a mean disability of 46.03% ± 9.64. The mean presurgery VAS score of the neck was 7.58 ± 0.85, while VAS score of the arm was 7.75 ± 1.008. Post surgery, NDI stated no disability, while VAS score of the neck and arm showed no presence of pain. The mean FR was 19.50 ± 21.71 levels per month, with a peak from 3
CONCLUSION
CONCLUSIONS
Multilevel stand-alone ACDF is a safe, cost-effective procedure providing favorable clinical and radiological results with minimal complications. The incidence of subsidence is usually clinically insignificant and can be decreased with a careful surgical technique.
Identifiants
pubmed: 33145206
doi: 10.4103/ajns.AJNS_196_19
pii: AJNS-15-554
pmc: PMC7591186
doi:
Types de publication
Journal Article
Langues
eng
Pagination
554-559Informations de copyright
Copyright: © 2020 Asian Journal of Neurosurgery.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
J Neurosurg Spine. 2004 Sep;1(2):160-7
pubmed: 15347001
J Bone Joint Surg Am. 2005 Mar;87(3):558-63
pubmed: 15741622
Neurosurgery. 1984 Oct;15(4):489-96
pubmed: 6493458
Spine (Phila Pa 1976). 2013 Jul 15;38(16):1409-21
pubmed: 23591658
Eur Spine J. 2007 Sep;16(9):1395-400
pubmed: 17221174
J Am Acad Orthop Surg. 2008 Dec;16(12):729-38
pubmed: 19056921
J Bone Joint Surg Am. 1999 Apr;81(4):519-28
pubmed: 10225797
J Manipulative Physiol Ther. 1991 Sep;14(7):409-15
pubmed: 1834753
Ann Rheum Dis. 1978 Aug;37(4):378-81
pubmed: 686873
Dysphagia. 2014 Feb;29(1):68-77
pubmed: 23943072
Spine (Phila Pa 1976). 2000 Mar 15;25(6):677-82
pubmed: 10752098
Global Spine J. 2019 Jun;9(4):446-455
pubmed: 31218204
Clin Neurol Neurosurg. 2015 May;132:47-51
pubmed: 25771116
Spine (Phila Pa 1976). 1984 Oct;9(7):667-71
pubmed: 6505833
J Bone Joint Surg Am. 1958 Jun;40-A(3):607-24
pubmed: 13539086
Spine (Phila Pa 1976). 2012 Sep 15;37(20):E1260-3
pubmed: 22744617
J Neurosurg. 1987 Jun;66(6):842-9
pubmed: 3572515
Spine J. 2007 Nov-Dec;7(6):633-6
pubmed: 17998121
J Korean Neurosurg Soc. 2017 Nov;60(6):691-700
pubmed: 29142629
Spine J. 2003 Nov-Dec;3(6):451-9
pubmed: 14609689
Spine (Phila Pa 1976). 1999 Mar 15;24(6):591-7
pubmed: 10101827
Spine (Phila Pa 1976). 2015 Feb 1;40(3):171-8
pubmed: 25668335
Kaohsiung J Med Sci. 2011 Nov;27(11):524-7
pubmed: 22005163
Am J Phys Med Rehabil. 2004 Mar;83(3):187-90
pubmed: 15043352
Orthopedics. 1988 Jun;11(6):931-4
pubmed: 3387340
Spine (Phila Pa 1976). 2007 Jul 1;32(15):1675-8; discussion 1679
pubmed: 17621217
Neurosciences (Riyadh). 2015 Jan;20(1):41-7
pubmed: 25630780
Spine (Phila Pa 1976). 2012 Sep 1;37(19):1645-51
pubmed: 22433506
Global Spine J. 2018 Oct;8(7):739-750
pubmed: 30443486
Spine (Phila Pa 1976). 2018 Feb 1;43(3):207-214
pubmed: 28604488
J Biomech. 1972 Mar;5(2):173-80
pubmed: 5020948
Clin Orthop Surg. 2011 Mar;3(1):16-23
pubmed: 21369474
J Bone Joint Surg Am. 1993 Sep;75(9):1298-307
pubmed: 8408151
Spine (Phila Pa 1976). 1993 Nov;18(15):2167-73
pubmed: 8278827
J Orthop Sci. 2005 Nov;10(6):564-73
pubmed: 16307181
J Neurosurg. 2001 Jul;95(1 Suppl):40-2
pubmed: 11453429