Stand-Alone Cages for Anterior Cervical Fusion: Are There No Problems?
OBJECTIVE
There are complications in stand-alone cage assisted anterior cervical discectomy and fusion (ACDF), such as cage subsidence and kyphosis. Here we report our clinical result on ACDF, comparing with stand-alone cages and with cervical plate system for degenerative cervical spine diseases.


METHODS
Patients with degenerative cervical disease who were diagnosed and treated in Konyang University Hospital between January 2004 and December 2014 were included in this study. Patients who had operation in single level ACDF were selected. Patients scored the degree of pain using visual analog scale before and after the surgery. Subsidence was defined as ≥3-mm decrease of the segmental height, and cervical kyphosis was defined as progression of ≥5° at 12 months after postoperative follow-up compared to that measured at the immediate postoperative period.


RESULTS
A total of 81 patients were enrolled for this study. Forty-five patients were included in a cervical plate group and the others were in stand-alone cage group. There was no statistical difference in pain score between the 2 groups. Segmental subsidence was observed in 7 patients (15.6%) in plate-assisted cervical fusion group, and 13 patients (36.1%) in stand-alone cage group. Segmental kyphosis was observed in 4 patients (8.9%) in plate-assisted cervical fusion group, and 10 patients (27.8%) in stand-alone cage group. There was statistical difference between the 2 groups.


CONCLUSIONS
There was no difference in pain between 2 groups. But stand-alone case group showed higher incidence rate than plate-assisted cervical fusion group in segmental subsidence and cervical kyphosis. When designing cervical fusion, more attention should be given selecting the surgical technique.
Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejon, Korea.
Sang Youp
SY
Han
Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejon, Korea.
Hyun Woo
HW
Kim
Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejon, Korea.
Cheol Young
CY
Lee
Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejon, Korea.
Hong Rye
HR
Kim
Department of Anesthesiology, Konyang University Hospital, Konyang University Collge of Medicine, Daejon, Korea.
Dong Ho
DH
Park
Cervical kyphosis; Plate-assisted cervical fusion; Segmental subsidence; Stand-alone cervical fusion