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CC BY 4.0 · Avicenna J Med 2024; 14(04): 216-222
DOI: 10.1055/s-0044-1801833
Original Article

Comparative Radiological Outcomes of Stand-alone Cage versus Cage and Plate in Anterior Cervical Discectomy and Fusion: A Retrospective Cohort Study

Isam Sami Moghamis
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
,
Abduljabbar Alhammoud
2   Department of Orthopedic Surgery, University of Arizona, Tucson, Arizona
,
Amgad M. Elshoeibi
3   College of Medicine, Qatar University, QU Health, Doha, Qatar
,
Abedallah Abudalou
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
,
Jawad Derbas
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
,
Mutaz Awad Alhardallo
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
,
Salahuddeen Abdelsalam
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
,
Abdulmoeen Baco
1   Department of Orthopedic Surgery, Hamad General Hospital, Doha, Qatar
› Institutsangaben Funding The authors received no funding from any individual or institution, and this work is completely voluntary work.
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Abstract

Background Anterior cervical discectomy and fusion (ACDF) is one of the most commonly used techniques for neural decompression in degenerative cervical radiculopathy and cervical myelopathy. Controversies regarding the superiority of cage augmentation with anterior cervical plate remain, yet several surgeons are still performing ACDF with a stand-alone cage (ACDF-SA). Our study aimed to compare the radiological outcomes between the ACDF augmented with anterior cervical plate (ACDF-CPA) and ACDF-SA in single-level cervical degenerative disc disease.

Methods A retrospective data review was conducted for patients who underwent ACDF between January 2011 and December 2019. All adult patients who underwent single-level ACDF for cervical radiculopathy and myelopathy with at least 12 months of follow-up were included in the study. Patients who had a systemic infection, trauma injury, history of malignancy, inadequate radiographs, and less than 12 months of follow-up were excluded from the study. Radiological outcomes, including cage subsidence, fusion rate, and adjacent segment degeneration, were assessed by two senior orthopaedic spine fellows. Adjusted risk ratios were used to compare the radiological outcomes of ACDF-SA and ACDF-CPA, adjusting for age and gender.

Results A total of 43 patients were included. Among them, 58% of the patients underwent a stand-alone cage ACDF, while 42% had anterior cervical plate augmentation. The overall fusion rate at 6 months was 76%. The ACDF-SA group's fusion rate was 88%, while that of the ACDF-CPA group was 61%. At 12 months, the overall fusion rate was 81% and was comparable between the two groups. Cage subsidence and adjacent segment degeneration rates were similar between the groups at 6 and 12 months. Adjusted relative risk analysis showed a 50% higher probability of fusion at 6 months in the ACDF-SA group compared with the ACDF-CPA group (95% confidence interval [CI]: 1.01–2.22) and a 22% higher probability at 12 months, though not statistically significant (95% CI: 0.90–1.64). Female gender was associated with higher fusion rates and lower subsidence risk at 12 months.

Conclusion Augmentation with the anterior cervical plate in ACDF did not show superiority to the conventional stand-alone cage in mono-segmental ACDF. Our study showed similar outcomes regarding cage subsidence, adjacent segment disease, and fusion rates at 12 months. However, the stand-alone cage achieved faster fusion at 6 months than the plate group.

Keywords

anterior cervical discectomy and fusion (ACDF) - anterior cervical plate - adjacent segment degeneration - stand-alone cage


Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Kulkarni AG, Hee HT, Wong HK. Solis cage (PEEK) for anterior cervical fusion: preliminary radiological results with emphasis on fusion and subsidence. Spine J 2007; 7 (02) 205-209
    CrossrefPubMedSuche in Google Scholar
  • 2 Song KJ, Taghavi CE, Hsu MS, Lee KB, Kim GH, Song JH. Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders. Eur Spine J 2010; 19 (10) 1677-1683
    CrossrefPubMedSuche in Google Scholar
  • 3 Yu J, Ha Y, Shin JJ. et al. Influence of plate fixation on cervical height and alignment after one- or two-level anterior cervical discectomy and fusion. Br J Neurosurg 2018; 32 (02) 188-195
    CrossrefPubMedSuche in Google Scholar
  • 4 Zhou J, Li J, Lin H, Li X, Zhou X, Dong J. A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: minimum 3-year assessment of radiographic and clinical outcomes. Clin Neurol Neurosurg 2018; 170: 73-78
    CrossrefPubMedSuche in Google Scholar
  • 5 Çelik SE, Kara A, Çelik S. A comparison of changes over time in cervical foraminal height after tricortical iliac graft or polyetheretherketone cage placement following anterior discectomy. J Neurosurg Spine 2007; 6 (01) 10-16
    CrossrefPubMedSuche in Google Scholar
  • 6 Demircan MN, Kutlay AM, Colak A. et al. Multilevel cervical fusion without plates, screws or autogenous iliac crest bone graft. J Clin Neurosci 2007; 14 (08) 723-728
    CrossrefPubMedSuche in Google Scholar
  • 7 Shad A, Leach JCD, Teddy PJ, Cadoux-Hudson TAD. Use of the Solis cage and local autologous bone graft for anterior cervical discectomy and fusion: early technical experience. J Neurosurg Spine 2005; 2 (02) 116-122
    CrossrefPubMedSuche in Google Scholar
  • 8 Xie Y, Chopin D, Hardouin P, Lu J. Clinical, radiological and histological study of the failure of cervical interbody fusions with bone substitutes. Eur Spine J 2006; 15 (08) 1196-1203
    CrossrefPubMedSuche in Google Scholar
  • 9 Buttermann GR. Prospective nonrandomized comparison of an allograft with bone morphogenic protein versus an iliac-crest autograft in anterior cervical discectomy and fusion. Spine J 2008; 8 (03) 426-435
    CrossrefPubMedSuche in Google Scholar
  • 10 Liao JC, Niu CC, Chen WJ, Chen LH. Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop 2008; 32 (05) 643-648
    CrossrefPubMedSuche in Google Scholar
  • 11 Meier U, Kemmesies D. Experiences with six different intervertebral disc spacers for spondylodesis of the cervical spine [in German]. Orthopade 2004; 33 (11) 1290-1299
    PubMedSuche in Google Scholar
  • 12 Connolly PJ, Esses SI, Kostuik JP. Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 1996; 9 (03) 202-206
    CrossrefPubMedSuche in Google Scholar
  • 13 Fraser JF, Härtl R. Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 2007; 6 (04) 298-303
    CrossrefPubMedSuche in Google Scholar
  • 14 Troyanovich SJ, Stroink AR, Kattner KA, Dornan WA, Gubina I. Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech 2002; 15 (01) 69-74
    CrossrefPubMedSuche in Google Scholar
  • 15 Oshina M, Oshima Y, Tanaka S, Riew KD. Radiological fusion criteria of postoperative anterior cervical discectomy and fusion: a systematic review. Global Spine J 2018; 8 (07) 739-750
    CrossrefPubMedSuche in Google Scholar
  • 16 Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999; 81 (04) 519-528
    CrossrefPubMedSuche in Google Scholar
  • 17 Norton EC, Miller MM, Kleinman LC. Computing adjusted risk ratios and risk differences in stata. Stata J 2013; 13 (03) 492-509
    CrossrefSuche in Google Scholar
  • 18 Kast E, Derakhshani S, Bothmann M, Oberle J. Subsidence after anterior cervical inter-body fusion. A randomized prospective clinical trial. Neurosurg Rev 2009; 32 (02) 207-214 , discussion 214
    CrossrefPubMedSuche in Google Scholar
  • 19 Moreland DB, Asch HL, Clabeaux DE. et al. Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 2004; 4 (02) 184-191 , discussion 191
    CrossrefPubMedSuche in Google Scholar
  • 20 Gercek E, Arlet V, Delisle J, Marchesi D. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 2003; 12 (05) 513-516
    CrossrefPubMedSuche in Google Scholar
  • 21 Joo YH, Lee JW, Kwon KY, Rhee JJ, Lee HK. Comparison of fusion with cage alone and plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc 2010; 48 (04) 342-346
    CrossrefPubMedSuche in Google Scholar
  • 22 Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 2007; 16 (09) 1395-1400
    CrossrefPubMedSuche in Google Scholar
  • 23 Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine 2009; 34 (26) 2886-2892
    CrossrefPubMedSuche in Google Scholar
  • 24 Zhao Y, Yang S, Huo Y, Li Z, Yang D, Ding W. Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials. Eur Spine J 2020; 29 (11) 2734-2744
    CrossrefPubMedSuche in Google Scholar
  • 25 Zhang Y, Ju J, Wu J. Self-locking stand-alone cage versus cage-plate fixation in monosegmental anterior cervical discectomy and fusion with a minimum 2-year follow-up: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18 (01) 403
    CrossrefPubMedSuche in Google Scholar
  • 26 Kahaer A, Chen R, Maitusong M, Mijiti P, Rexiti P. Zero-profile implant versus conventional cage-plate construct in anterior cervical discectomy and fusion for the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17 (01) 506
    CrossrefPubMedSuche in Google Scholar
  • 27 Cheung ZB, Gidumal S, White S. 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 (04) 446-455
    CrossrefPubMedSuche in Google Scholar
  • 28 Lynch CP, Cha EDK, Patel MR. et al. Effects of anterior plating on achieving clinically meaningful improvement following single-level anterior cervical discectomy and fusion. Neurospine 2022; 19 (02) 315-322
    CrossrefPubMedSuche in Google Scholar
  • 29 Zhu D, Zhang D, Liu B, Li C, Zhu J. Can self-locking cages offer the same clinical outcomes as anterior cage-with-plate fixation for 3-level anterior cervical discectomy and fusion (ACDF) in mid-term follow-up?. Med Sci Monit 2019; 25: 547-557
    CrossrefPubMedSuche in Google Scholar
  • 30 Wang F, Hou HT, Wang P, Zhang JT, Shen Y. Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: incidence and risk factors. Medicine (Baltimore) 2017; 96 (47) e8663
    CrossrefPubMedSuche in Google Scholar
  • 31 Gandhi SD, Fahs AM, Wahlmeier ST. et al. Radiographic fusion rates following a stand-alone interbody cage versus an anterior plate construct for adjacent segment disease after anterior cervical discectomy and fusion. Spine 2020; 45 (11) 713-717
    CrossrefPubMedSuche in Google Scholar
  • 32 Li XF, Jin LY, Liang CG, Yin HL, Song XX. Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study. BMC Surg 2020; 20 (01) 66
    CrossrefPubMedSuche in Google Scholar
  • 33 Jin LY, Wei K, Feng DM. et al. Changes of adjacent segment biomechanics after anterior cervical interbody fusion with different profile design plate: single- versus double-level. Comput Methods Biomech Biomed Engin 2023; 26 (06) 744-753
    CrossrefPubMedSuche in Google Scholar