Abstract
Introduction
Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed by spine surgeons to treat cervical degenerative disc disease. Use of anterior spacer and plate system (ASPS) results in increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rates than a spacer alone.1,2 However, anterior cervical plating (ACP) is associated with significant complications, such as dysphagia, plate screw dislodgement, soft tissue injury, esophagus perforation, and neural injury.3–9 Integrated spacer and plate (ISP) or zero-profile cage systems have recently gained popularity among spine surgeon to reduce the drawbacks of the ASPS technique. The objective of this study is to retrospectively evaluate and compare clinical and radiographical outcome of patients after two-level ACDF with IPS and traditional two-level ASPS.
Materials and Methods
From January 2007 to October 2014, a total of 84 consecutive patients with cervical degenerative disc disease who underwent two-level ACDF using the ISP or the ASPS were reviewed for clinical and radiographical outcomes. Patient reported VAS and NDI scores, fusion rates, hardware failure were recorded at 1, 3, 6, 12, and 24 months after surgery.
Results
Forty-three patients received ISP and forty-one patients received ASPS. There were no statistical differences in patient demographics between the two groups. In regards to operative details, there was no statistical differences except ISP were done almost exclusively with autograft and ASPS with allograft. Overall, there were no statistical differences in VAS scores, NDI scores and fusion status between the two groups (p > 0.05). At the proximal surgical level, there was a trend toward an earlier observed radiographic fusion rate in the ASPS group, 6.8 ± 5.4 months compared with ISP group, 8.3 ± 5.5 months (p = 0.09). Similarly, the observed radiographic fusion rate at the distal surgical level in the ASPS group was 7.0 ± 6.2 months and in the ISP group was 8.1 ± 5.5 months (p = 0.12). One case of long-term dysphagia (> 3 months) was reported in each group. Both groups had no reports of implant failures.
Conclusion
The integrated spacers and plate for two-level ACDF compared with traditional anterior spacer and plate system may provide comparable clinical and radiographical outcome at two years. However, there may be an earlier observed radiographical fusion in the ASPS group and no difference in long-term reported dysphagia rate.