Introduction: The stand-alone (SA), zero-profile implant has become an attractive alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF) for the treatment of degenerative cervical spondylosis. To date, many studies comparing SA versus CP for ACDF have concluded equivocal and mixed results. The objective of our study was to further characterize differences between the two groups by using the largest cohort to date.

Methods: The authors conducted a retrospective analysis of patients for single and multilevel ACDF procedures between August 2013 and March 2016 with the use of either a SA (Globus Spine) or anterior CP (DePuys Synthes Spine) system. McNab scores were used and documented along with dysphagia rates determined using the Bazaz criteria. A multivariate logistic regression model was built to assess factors that predicted poor and good outcomes.

Results: A total of 170 patients underwent ACDF in the study (75 males and 95 females; mean age 53±13) with a total follow up mean period of 9 ±3 months. 112 patients had SA (61 single-level, 38 two-levels, and 13 three-levels) and 58 patients underwent CP with cage implants (26 single-level, 28 two-levels, and 4 three-levels). Indications for surgery were radiculopathy (50%), myeloradiculoapthy (22%), myelopathy (21%), and intractable pain (7%). In the SA, 96% of patients had no dysphagia and 4% had mild dysphagia at 3 months. Similarly, for CP, 93% of patients had no dysphagia and 7% had mild dysphagia at 3 months. Eight-five per cent of patients had a good-to-excellent satisfaction outcome based on McNab. From the multivariate analysis, cervical plating was strongly associated with poor outcome (OR 2.85 (CI 95% 1.21-6.83), p value=0.017).

Conclusions: Based on our study of 170 patients, SA was superior to CP for single and multilevel ACDF in patient satisfaction rates.

Patient Care: Anterior cervical discectomy and fusion is one of the most used and best validated surgeries in spine for treating a myriad of cervical degenerative spondylotic disorders. With the advent of newer technology, it becomes important to determine how this technology compares to existing methods as it pertains to outcomes. I believe the results of our study show that stand-alone implants for ACDF are as good and at times better with respect to several surgical variables when compared to cervical plating.

Learning Objectives: Using the largest cohort to date, to determine if one ACDF approach was superior to the other (SA vs CP), or if both were equivocal. Several variables were obtained and assessed for this objective.

References: Shao H et al., Journal of Orthopedic Surgery and Research 2015 Chen Y et al., Clinical Neurology and Neurosurgery 2016 Njoku I et al., J neurosurg spine 2014