Introduction: anterior cervical discectomy and fusion(ACDF) has become the classic operation in treating degenerative cervical spondylosis.The application of cervical plate although might cause dysphagia on the other hand it gives additional rigidity,higher fusion rates,and reduced kyphosis.incorporate fixation into the graft itself makes it containment and increased fusion construct rigidity
Methods: 30 patients operated upon from January 2012 to August 2012 by ACDF using the PEEK PREVAIL Cervical Interbody Device. patients evaluated clinically using the visual analogue score for pain and the myelopathy JOA score and Nurick score preoperative MRI and x-rays were evaluated and postoperative x rays was used to evaluate the fusion and measure the cervical spine sagittal alignment,segmental angle of the treated levels,amount of segmental collapse.Pre and postoperative dysphagia were also reported.
Results: 30 patients(21 males and 9 females).age ranged from 29 to 68. visual analogue score was 9.0(ranging 8.0 to 10.0, preoperatively and the final mean was 1.67 statistically significantThe JOA for myelopathy also showed a statistically significant change (p value< 0.001)with a preoperative mean of 7.12 (ranging 2.0 to 13.0) and a postoperative mean of 14.65(ranging 11.0 to 17.0).the Nurick score change with a preoperative mean of 2.6 (ranging 1.0 to 5.0) and a postoperative mean of 0.83(ranging 0.0 to 3.0). The meanpreoperative fused levels height was 33.423 (ranging 23.5 to 56.4) while the mean postoperative final fused levels heights was 40.463 (ranging 30.1 to 60.9). This difference between preoperative and postoperative values was statistically significant p value of < 0.001.all operated cases reached to solid fusion in late follow up, with no cases of failure of fusion or peudoarthrosis.
Conclusions: clinical and radiological criteria were significantly improved postoperatively particularly in the decrease of postoperative degree of cage subsidence which reflect the adjacent level disease. However, this improvement might not be implant specific and it may be instead related primarily to the standard decompression and fusion performed. This argument need to be discussed in a comparative study using different types of implants comparing it with fusion and fixation with plate specially in multiple levels anterior cervical discectomy and fusion.
Patient Care: This types of cages used decrease the incidence of cage subsidence and on the other hand may reflect the decrease of adjacent level disease, on the other hand the screw fixation decrease the micro-motion in the fused level(s) promoting the early solid fusion decreasing the implant failure, added to the criteria of zero profile decreasing the incidence of postoperative dysphagia
Learning Objectives: to evaluate the efficacy of anterior cervical microdiscectomy and fusion carried out using a newly designed interbody spacer anchored with screws clinically and radiologicaly.