Abstract
Introduction
To review and analyze the clinical outcome and radiological changes of one-level and two-level anterior cervical discectomy and fusion (ACDF) with stand-alone Trabecular Metal™ cages. ACDF using a stand-alone cage is a popular procedure with little published long-term follow-up, we reviewed our cases performed between 2001–2011.
Material and Methods
Patients between 36 and 64 years of age, diagnosed with cervical radiculopathy, who underwent ACDF were available for at least 3 years follow-up and included in this study. All levels were low-cervical (below C4). Clinical outcomes were assessed using Odom's Criteria, VAS, and by assessing axial neck pain, radicular arm pain, upper extremity weakness, and upper extremity numbness. Fusion was assessed by lateral radiographs looking for bone breaching and radiolucent lines around the device, in addition to dynamic radiographs, postoperative cervical lordosis was measured by the Drexler Method
Results
Ninety patients were included in the study, 51 patients underwent two-level ACDF modified Robinson approach, and 39 patients underwent one-level ACDF. Mean age was 44 ± 10.4 years and mean follow-up time was 4.5 ± 2.6 years. Patients reported excellent or good outcomes (90%), VAS improved in 90% of patients from a mean of 3 preoperatively, to a mean of 9 at 1 year, and a mean of 8 at 3 years follow up. Improvement in axial neck pain (80%), radicular arm pain (95%), upper extremity weakness (85%), and upper extremity numbness (90%). No cage extrusion or migration occurred. Subsidence occurred in 8% of levels fused. Clinical improvements were not related to the occurrence of subsidence. Radiographs confirmed restoration of cervical lordosis above 45 degrees, with maintenance over the follow up period. There was symptomatic anterior osteophytes formation or calcifications of anterior longitudinal ligament in 25% of patients at the final follow-up; the reoperation rate was 3.6%. There was no persistent dysphagia, or voice complaints, no dural tear, tracheal or oesophageal perforation. One patient developed deep MRSA infectious infarction of spinal cord, treated with antibiotics, and recovered totally upon one-year follow up. Based on the 3 criteria for fusion, 90% of patients confirmed fusion at 1 year follow up.
Conclusion
Mid- to long-term results show that ACDF with Trabecular Metal™ cages is safe and effective treatment of single and two-level cervical disc radiculopathy and neck pain.