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The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion

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Abstract

Purpose

We aimed to identify technique-related factors influencing radiographic and patient-rated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF).

Methods

This single center study was nested within the Eurospine Spine Tango data acquisition system. Inclusion criteria: consecutive two-level ACDF patients (2004–2012) presenting with signs of degenerative cervical radiculopathy or myelopathy. Before and 12 month postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI); at 12 months postoperatively they also rated the global treatment outcome (GTO) and their satisfaction with care. Cervical lordosis and segmental height were assessed radiographically preoperatively, immediately postoperatively, and at the last follow-up (LFU) (18.2 ± 13.3 months).

Results

One hundred and forty-four consecutive patients (113 with APF) were included. The use of APF versus stand-alone methods was associated with significantly increased segmental height (by 2.6 ± 2.6 versus 1.5 ± 2.4 mm, p = 0.04) and preservation of lordosis (by 2.7 ± 4.4° versus −1.7 ± 5°, p < 0.0001) at LFU, with comparable clinical outcome (COMI score reduction ≥3.1-point). Multiple regression controlling for potential confounders revealed that APF (p = 0.0004) and cage (p = 0.001) were associated with greater segmental height at LFU; APF was associated with a greater lordosis angle at LFU (p < 0.0001). Greater increase in segmental height at LFU (p = 0.02) was associated with a better GTO.

Conclusions

Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO.

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References

  1. Cunningham MR, Hershman S, Bendo J (2010) Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 35(5):537–543. doi:10.1097/BRS.0b013e3181b204cc-201003010-00012

    Article  Google Scholar 

  2. Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Resnick DK, Joint Section on Disorders of the Spine, Peripheral Nerves of the American Association of Neurological Surgeons, Congress of Neurological Surgeons (2009) Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine 11(2):183–197. doi:10.3171/2009.2.SPINE08721

    Article  PubMed  Google Scholar 

  3. Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A(3):607–624

    CAS  PubMed  Google Scholar 

  4. Jacobs W, Willems PC, Kruyt M, van Limbeek J, Anderson PG, Pavlov P, Bartels R, Oner C (2011) Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976) 36(14):E950–E960. doi:10.1097/BRS.0b013e31821cbba5

    Article  Google Scholar 

  5. Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am 88(7):1619–1640. doi:10.2106/JBJS.F.00014

    Article  PubMed  Google Scholar 

  6. Chen Y, Wang X, Lu X, Yang L, Yang H, Yuan W, Chen D (2013) Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J 22(7):1539–1546. doi:10.1007/s00586-013-2772-y

    Article  PubMed Central  PubMed  Google Scholar 

  7. Guo Q, Bi X, Ni B, Lu X, Chen J, Yang J, Yu Y (2011) Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J 20(9):1539–1544. doi:10.1007/s00586-011-1735-4

    Article  PubMed Central  PubMed  Google Scholar 

  8. Kim CH, Chung CK, Hahn S (2013) Autologous iliac bone graft with anterior plating is advantageous over the stand-alone cage for segmental lordosis in single-level cervical disc disease. Neurosurgery 72(2):257–265. doi:10.1227/NEU.0b013e31827b94d4 (discussion 266)

    Article  PubMed  Google Scholar 

  9. Daffner SD, Wang JC (2009) Anterior cervical fusion: the role of anterior plating. Instr Course Lect 58:689–698

    PubMed  Google Scholar 

  10. Joo YH, Lee JW, Kwon KY, Rhee JJ, Lee HK (2010) Comparison of fusion with cage alone and plate instrumentation in two-level cervical degenerative disease. J Korean Neurosurg Soc 48(4):342–346. doi:10.3340/jkns.2010.48.4.342

    Article  PubMed Central  PubMed  Google Scholar 

  11. Oh JK, Kim TY, Lee HS, You NK, Choi GH, Yi S, Ha Y, Kim KN, Yoon DH, Shin HC (2012) Stand-alone cervical cages versus anterior cervical plate in 2-level cervical anterior interbody fusion patients: clinical outcomes and radiologic changes. J Spinal Disord Tech. doi:10.1097/BSD.0b013e31824c7d22

    Google Scholar 

  12. Grob D, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Luca A, Mutter U, Mannion AF (2010) A comparison of outcomes of cervical disc arthroplasty and fusion in everyday clinical practice: surgical and methodological aspects. Eur Spine J 19(2):297–306. doi:10.1007/s00586-009-1194-3

    Article  PubMed Central  PubMed  Google Scholar 

  13. Roder C, Chavanne A, Mannion AF, Grob D, Aebi M (2005) SSE Spine Tango–content, workflow, set-up Tango. Eur Spine J 14 (10):920–924. doi:10.1007/s00586-005-1023-2. http://www.eurospine.org-Spine

  14. Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026. doi:10.1007/s00586-005-0911-9

    Article  PubMed  Google Scholar 

  15. Mannion AF, Porchet F, Kleinstuck FS, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective. Part 1: the Core Outcome Measures Index in clinical practice. Eur Spine J 18(Suppl 3):367–373. doi:10.1007/s00586-009-0942-8

    Article  PubMed Central  PubMed  Google Scholar 

  16. Burkhardt JK, Mannion AF, Marbacher S, Dolp PA, Fekete TF, Jeszenszky D, Porchet F (2013) A comparative effectiveness study of patient-rated and radiographic outcome after 2 types of decompression with fusion for spondylotic myelopathy: anterior cervical discectomy versus corpectomy. Neurosurg Focus 35(1):E4. doi:10.3171/2013.3.FOCUS1396

    Article  PubMed  Google Scholar 

  17. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP (2009) The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34(26):2886–2892. doi:10.1097/BRS.0b013e3181b64f2c

    Article  Google Scholar 

  18. Wu WJ, Jiang LS, Liang Y, Dai LY (2012) Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J 21(7):1374–1382. doi:10.1007/s00586-011-2131-9

    Article  PubMed Central  PubMed  Google Scholar 

  19. Liebensteiner MC, Jesacher G, Thaler M, Gstoettner M, Liebensteiner MV, Bach CM (2011) Restoration and preservation of disc height and segmental lordosis with circumferential lumbar fusion: a retrospective analysis of cage versus bone graft. J Spinal Disord Tech 24(1):44–49. doi:10.1097/BSD.0b013e3181d67c7c

    Article  PubMed  Google Scholar 

  20. Kim MK, Kim SM, Jeon KM, Kim TS (2012) Radiographic comparison of four anterior fusion methods in two level cervical disc diseases: autograft plate fixation versus cage plate fixation versus stand-alone cage fusion versus corpectomy and plate fixation. J Korean Neurosurg Soc 51(3):135–140. doi:10.3340/jkns.2012.51.3.135

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland

    Jan-Karl Burkhardt, Serge Marbacher & François Porchet

  2. Department of Research and Development, Spine Center, Schulthess Clinic, Zurich, Switzerland

    Anne F. Mannion

  3. Department of Orthopedic Surgery, Spine Center, Schulthess Clinic, Zurich, Switzerland

    Frank S. Kleinstück & Dezsö Jeszenszky

Authors
  1. Jan-Karl Burkhardt
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  2. Anne F. Mannion
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  3. Serge Marbacher
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  4. Frank S. Kleinstück
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  5. Dezsö Jeszenszky
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  6. François Porchet
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Correspondence to Jan-Karl Burkhardt.

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Burkhardt, JK., Mannion, A.F., Marbacher, S. et al. The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion. Eur Spine J 24, 113–119 (2015). https://doi.org/10.1007/s00586-014-3456-y

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  • DOI: https://doi.org/10.1007/s00586-014-3456-y

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