Radiographic analysis of fusion progression following one-level cervical fusion with or without plate fixation.
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) using bone graft or a cage with plate fixation is an accepted technique for the treatment of symptomatic degenerative disc disease. It is, however, debatable whether a plate is really necessary to increase the progress of fusion. Thus, the aim of this randomized and controlled prospective study was to evaluate whether ACDF with a cage and anterior plate fixation results in a greater progress of fusion compared with ACDF using a stand-alone cage.


METHODS
37 candidates for ACDF were treated either with a stand-alone cage (study group) or with a cage+plate fixation (control group). 19 patients were randomized to be stabilized with a stand-alone cage and 18 patients were treated with a cage and additional anterior plate fixation. The progress of cervical fusion over time was compared by radiostereometric analysis (RSA). Follow-up examinations pre- and postoperatively were done using the Visual Analogue Scale (VAS) for neck and arm pain. Radiographic assessment of fusion using an RSA-control was done after one, six and twelve weeks, as well as after six months, and one and two years postoperatively. Mann-Whitney test for unpaired values was used to determine the statistical differences in residual intervertebral motion.


RESULTS
Three-dimensional analysis of segmental motion (left-right, cranio-caudal, and posterior-anterior) did not reveal any statistical differences between both groups at any examination time postoperatively ( P>0.05). The VAS score did not differ between the groups ( P>0.05).


CONCLUSIONS
Anterior plate fixation did not demonstrate an improvement in the progress of fusion in one-level ACDF.
Nabhan
A
A
Department of Neurosurgery, University of Saarland, Homburg, Germany. dr_a_nabhan@hotmail.com
Pape
D
D
Pitzen
T
T
Steudel
W-I
WI
Bachelier
F
F
Jung
J
J
Ahlhelm
F
F
D001132:Arm; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000523:psychology; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D010147:Pain Measurement; D011446:Prospective Studies; D011859:Radiography; D013123:Spinal Fusion; D013131:Spine / Q000000981:diagnostic imaging*