Comparison of plate-cage construct and stand-alone anchored spacer in the surgical treatment of three-level cervical spondylotic myelopathy: a preliminary clinical study.
BACKGROUND
Although stand-alone cages were advocated to be superior to plate-cage construct (PCC) because of comparable clinical outcomes and fewer plate-related complications, cage dislocation and subsidence were frequently mentioned in multilevel fusion. There are some concerns about whether these issues can be effectively prevented in multilevel anterior cervical discectomy and fusion (ACDF) by stand-alone anchored spacer (SAAS).


OBJECTIVE
The aim was to compare clinical outcomes, radiologic parameters, and complications of PCC and SAAS in the treatment of three-level cervical spondylotic myelopathy (CSM).


METHODS
This was a retrospective comparative study.


METHODS
A total of 38 consecutive patients with three-level CSM (ACDF with PCC, 20 patients; ACDF with SAAS, 18 patients) were reviewed.


METHODS
Clinical outcomes were assessed using Japanese Orthopaedic Association and Neck Disability Index. The radiologic evaluations included cervical alignment (CA), segmental angle (SA), postoperative curvature loss (PCL), and incidence of subsidence.


METHODS
All the aforementioned parameters were compared before and after surgery between two groups. Besides, the aforementioned results were also compared between the two groups. The complications were also recorded.


RESULTS
The mean follow-up period was 30.3 months. No significant differences were observed in clinical outcomes between the two groups (p>.05). Additionally, no significant differences existed in fusion rate between the two groups. There were significant differences in PCL of SA and CA and correction of SA between the two groups (p<.05). Besides, the incidence of subsidence (9 of 54 levels, 16.7%) was recorded in the SAAS group, and the potential of SAAS to reduce the incidence of postoperative dysphagia was not proven. No other complications were observed in this study.


CONCLUSIONS
In the surgical treatment of three-level CSM, PCC is superior to SAAS in correction and maintenance of SA and avoiding cage subsidence, although the technique of ACDF with SAAS yielded encouraging clinical outcomes and high fusion rate.
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Shanghai 200127, P.R. China.
Sheng
S
Shi
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Shanghai 200127, P.R. China. Electronic address: rjliuzd@163.com.
Zu-De
ZD
Liu
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Shanghai 200127, P.R. China.
Xin-Feng
XF
Li
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Shanghai 200127, P.R. China.
Lie
L
Qian
Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Shanghai 200127, P.R. China.
Gui-Bin
GB
Zhong
Department of Orthopaedic Surgery, General Hospital of Jinan Military Command of PLA, No. 25 Shifan Rd, Jinan 250012, P.R. China.
Fang-Jing
FJ
Chen
D000368:Aged; D001860:Bone Plates / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013166:Spondylitis / Q000601:surgery*
Anterior cervical discectomy and fusion; Dysphagia; Lordosis loss; Stand-alone anchored spacer; Subsidence; Zero-P