Introduction: Anterior cervical discectomy and fusion remains the gold standard for treatment of degenerative cervical spine disorders. Cage-assisted ACDF has proven to be a safe and effective procedure for the treatment of cervical degenerative disc disease.
In multiple level disc disease cervical plating has been advised. Plate fixation may decrease the micro-movement of the cervical spine, enhance the fusion rate, and correct spinal curve to physiologic lordosis. Thus leading to higher fusion rate, lower reoperation rate, and better pain relief.
However, the use of an anterior plate system is associated with various intraoperative and postoperative complications. The application of long ACPs, particularly during multilevel cervical discectomy and fusion, is a time-consuming procedure, and can lead to various complications such as; screw pullout, screw breakage, injury of the laryngeal nerves, dysphagia or even injury of the oesophagus, and wound infection.
Methods: This is a prospective study analyzing the results of ACDF with stand-alone cage fusion in 30 cases of 3 or 4 levels degenerative cervical disc disease.
Results: 27 cases (90%) had favorable outcome (solid fusion, resolution of all symptoms and maintenance of cervical lordosis) after at least 12 months follow up.
Three cases (10%) needed reoperation. One case operated for C3-4, 4-5 and 5-6 needed reoperation for adjacent segment degeneration. One case developed postoperative discitis after C4-5,5-6, 6-7 discectomy at the later level and needed C6 corpectomy and Pyramesh fusion and anterior plating. A third case developed cage subsidence due to excess removal of the endplate and needed reoperation for corpectomy and fusion and fixation, yet the patient declined surgery.
Conclusions: In conclusion we recommend that ACDF with stand-alone cage fusion is a safe and effective measure in treatment of 3 or 4 level cervical disc disease with no need of cervical plating.
Patient Care: We believe that omitting the use of the long anterior plate system, will shorten the time of surgery, avoid potential complications of long anterior cervical plating. And stand alone PEEK cage in 3 and 4 levels can achieve high rates of fusion and good clinical outcome, comparable to that with the use of anterior cervical plate.
Learning Objectives: -ACDF using stand alone cage is an effective and safe method for surgical management of 3 and 4 level degenerative cervical disc disease.
-Avoiding excess removal of the cartilaginous end plate is of paramount importance to reduce the incidence of cage subsidence.
-Selecting appropriate sized cage with avoiding over-distraction is also an important factor in reducing cage subsidence.