title: Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating.
abstract: METHODS
  A retrospective cohort-nested longitudinal study.
  
  
  OBJECTIVE
  To evaluate radiologic and clinically functional outcomes after single-level anterior cervical discectomy and fusion (ACDF) using 3 different fusion construct systems applying an accurate and reliable methodology.
  
  
  BACKGROUND
  ACDF is an established procedure that uses 3 different fusion construct systems: cage alone (CA), iliac tricortical bone block with plate (IP), and cage with plate construct (CP). The outcome of a previous study is quite different and did not correlate with experimental studies.
  
  
  METHODS
  ACDF was performed on 158 patients (90 male and 68 female), who were followed up for >12 months. The patients were divided into the following 3 treatment groups: CA, IP, and CP. Factors related to outcome were also evaluated. Fusion rate, subsidence rate, and cervical angles were used to measure radiologic outcome. The Odom criteria and the visual analog scale were used to evaluate the clinical outcome.
  
  
  RESULTS
  The fusion rate was higher for patients in the IP (87.1%) and CP (79.5%) groups than for those in the CA group (63.2%) after 12 months of follow-up (P=0.019). The subsidence rate was lower for patients in the IP (28.1%) and CP (38.5%) groups than for those in the CA group (58.6%) (P=0.010). Subsidence occurred for the anterior height regardless of constructs. Radiating arm pain showed greater relief in the CP group than in the CA group (P=0.015). It improved more in the CP group than in the IP group, but the differences were not statistically significant (P=0.388). Other clinical outcomes did not show significant differences.
  
  
  CONCLUSIONS
  The trend of excellent radiologic outcome was observed for IP≥CP>CA. Plating may play a key role in the support of anterior height. As a result, plating prevents segmental kyphosis and subsidence and promotes bone fusion. Although the overall clinical outcomes were not different among the 3 groups, except for arm pain, more favorable trends regarding clinical outcome were observed for CP≥IP>CA.
authors.affiliation: Departments of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Gyeonggi-do, Republic of Korea.
authors.forename: Chang-Hyun
authors.initials: CH
authors.lastname: Lee
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
authors.forename: Min Jeong
authors.initials: MJ
authors.lastname: Kim
authors.forename: Jin S
authors.initials: JS
authors.lastname: Yeom
authors.forename: Wook Ha
authors.initials: WH
authors.lastname: Kim
authors.forename: Ki-Jeong
authors.initials: KJ
authors.lastname: Kim
authors.forename: Tae-Ahn
authors.initials: TA
authors.lastname: Jahng
authors.forename: Hyun-Jib
authors.initials: HJ
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000592:standards; D016025:Bone Transplantation / Q000379:methods* / Q000592:standards; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D055815:Young Adult