Anterior cervical diskectomy and fusion without plate instrumentation in 178 patients.
Between 1989 and 1996, fusion, pseudarthrosis, repeated operation rates, and outcomes were studied in 178 patients undergoing one- to four-level (average, 2.2 levels) anterior cervical diskectomy and fusion (ADF) without plating. Dynamic radiographs taken 3 and 6 months after operation showed fusion or pseudarthrosis without motion in 99% of patients after one-level ADF (78 patients), in 90% after two-level ADF (84 patients), and in 100% after three-level ADF (12 patients) and four-level ADF (4 patients). Pseudarthrosis with motion was noted in 1% after one-level ADF and in 10% after two-level ADF (statistically significant with a lower pseudarthrosis rate in the 1-level; by Fisher's exact test, p = 0.0351). Three patients required secondary posterior wiring and fusion. Good or excellent outcomes (by Odom's criteria) were achieved in 96% of patients within an average of 82 months. Although fusion rates for one-level ADF without plates appear adequate, high pseudarthrosis rates after two-level ADF warrant that plating be considered.
Epstein
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Department of Surgery (Neurosurgery), North Shore University Hospital, Manhasset, New York, USA.
D000328:Adult; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D003668:Pressure Ulcer / Q000382:microbiology; D011446:Prospective Studies; D011542:Pseudarthrosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation / Q000706:statistics & numerical data; D013123:Spinal Fusion / Q000379:methods*; D013530:Surgical Wound Infection; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome