title: Smith-Robinson Procedure with an Autologous Iliac Crest Graft and Caspar Plating: Report of 65 Patients with an Average Follow-up of 22 Years.
abstract: BACKGROUND
  Anterior cervical discectomy and fusion with plate stabilization (ACDF+PS) is an accepted surgical procedure. We sought to evaluate the long-term clinical results of ACDF+PS with a special focus on pain, functional outcome, and adjacent segment disease.
  
  
  METHODS
  Retrospectively, 139 patients who underwent ACDF+PS were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EuroQuol-5 Dimension, Patient Satisfaction Index, Hospital Anxiety and Depression Scale, the Odom criteria, complications at the iliac crest donor side, and limitations in quality of life.
  
  
  RESULTS
  Mean follow-up time was 22 years (range: 17-34 years). Sixty five (46.8%) patients were evaluated by completed questionnaires, and 74 (53.2%) did not participate. Forty-six patients attended a physical examination. ACDF+PS were performed at 1 level in 28 patients, at 2 levels in 29 patients, and at 3 levels in 8 patients. Fifty (83.3%) of the patients with preoperative pain remained free of pain and did not require another procedure as the result of degenerative cervical disease. The mean NDI was 14%; according to the Odom criteria 86.2% of patients reported good-to-excellent functional recovery. A total of 100% of patients were satisfied or very satisfied with their outcome and would decide to undergo ACDF+PS again. Two developed adjacent segment disease and needed a second procedure.
  
  
  CONCLUSIONS
  ACDF+PS resulted in a significant increase in function, pain relief, and to a high degree of patient satisfaction. The rate for symptomatic adjacent segment disease was 4.5% after 20 years' follow-up.
authors.affiliation: Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany. Electronic address: benedikt.burkhardt@uks.eu.
authors.forename: Benedikt W
authors.initials: BW
authors.lastname: Burkhardt
authors.affiliation: Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Brielmaier
authors.affiliation: Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Schwerdtfeger
authors.affiliation: Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
authors.forename: Salman
authors.initials: S
authors.lastname: Sharif
authors.affiliation: Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany.
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Oertel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000706:statistics & numerical data; D015984:Causality; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D015897:Comorbidity; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D017586:Diskectomy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation; D055959:Intervertebral Disc Degeneration / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D010154:Pakistan / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D014182:Transplantation, Autologous / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: ACDF; ASD; Adjacent segment disease; Cervical fusion; Cervical plate fixation; Degenerative cervical disc disease; Long-term follow-up