title: The influence of cervical plate fixation with either autologous bone or cage insertion on radiographic and patient-rated outcomes after two-level anterior cervical discectomy and fusion.
abstract: OBJECTIVE
  We aimed to identify technique-related factors influencing radiographic and patient-rated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF).
  
  
  METHODS
  This single center study was nested within the Eurospine Spine Tango data acquisition system.
  
  
  METHODS
  consecutive two-level ACDF patients (2004-2012) presenting with signs of degenerative cervical radiculopathy or myelopathy. Before and 12 month postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI); at 12 months postoperatively they also rated the global treatment outcome (GTO) and their satisfaction with care. Cervical lordosis and segmental height were assessed radiographically preoperatively, immediately postoperatively, and at the last follow-up (LFU) (18.2 ± 13.3 months).
  
  
  RESULTS
  One hundred and forty-four consecutive patients (113 with APF) were included. The use of APF versus stand-alone methods was associated with significantly increased segmental height (by 2.6 ± 2.6 versus 1.5 ± 2.4 mm, p = 0.04) and preservation of lordosis (by 2.7 ± 4.4° versus -1.7 ± 5°, p < 0.0001) at LFU, with comparable clinical outcome (COMI score reduction ≥3.1-point). Multiple regression controlling for potential confounders revealed that APF (p = 0.0004) and cage (p = 0.001) were associated with greater segmental height at LFU; APF was associated with a greater lordosis angle at LFU (p < 0.0001). Greater increase in segmental height at LFU (p = 0.02) was associated with a better GTO.
  
  
  CONCLUSIONS
  Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO.
authors.affiliation: Department of Neurosurgery, Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland, JanKarl.Burkhardt@gmail.com.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.forename: Anne F
authors.initials: AF
authors.lastname: Mannion
authors.forename: Serge
authors.initials: S
authors.lastname: Marbacher
authors.forename: Frank S
authors.initials: FS
authors.lastname: Kleinstück
authors.forename: Dezsö
authors.initials: D
authors.lastname: Jeszenszky
authors.forename: François
authors.initials: F
authors.lastname: Porchet
mesh_terms: D001860:Bone Plates; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*