title: Can an Anchored Cage be Substituted for an Anterior Cervical Plate and Screw for Single-Level Anterior Cervical Fusion Surgery?: Prediction of Poor Candidates Through a Review of Early Clinical and Radiologic Outcomes.
abstract: METHODS
  This is a case series of device failure patients.
  
  
  OBJECTIVE
  To identify poor candidates for anterior cervical discectomy and fusion (ACDF) using an anchored cage.
  
  
  BACKGROUND
  An anchored cage has been used as an alternative implant for ACDF surgery because of ease of use, relatively acceptable fusion rate, and lower risk of plate-related complications, including dysphagia.
  
  
  METHODS
  We retrospectively reviewed the outcomes of 36 patients who underwent ACDF using an anchored cage between January 2012 and December 2013. The initial diagnoses included 8 traumatic soft disk herniations without posterior ligamentous complex injury, 25 degenerative soft disk herniations, 1 degenerative foraminal stenosis, 1 traumatic soft disk herniation after reducing a unilaterally dislocated facet joint, and 1 subluxation of a previously implanted cervical artificial disk. We encountered 5 cases with poor outcomes and performed 3 revisions on the index level. We reviewed the clinical and radiologic data for 31 patients with reasonable outcomes and reviewed the failed 5 cases separately.
  
  
  RESULTS
  Among the 31 patients with reasonable outcomes, all the clinical parameters improved. For the radiologic outcomes, 10 cases of cage subsidence occurred and no patient experienced instability.Among the 5 patients with poor outcomes, 1 patient had traumatic soft disk herniation and a reduced unilaterally dislocated facet joint, 1 patient had subluxation of a previously implanted cervical artificial disk, and 3 patients had degenerative soft disk herniation and poor bone quality. Although 3 patients required revision surgeries, 2 patients showed only radiologic failures without revision.
  
  
  CONCLUSIONS
  We analyzed the short-term outcomes of ACDF using an anchored cage and observed 5 patients with poor outcomes among 36 patients. We recommend the use of a single anchored cage for patients with definite evidence of posterior column stability and healthy bone.
  
  
  METHODS
  Level 3.
authors.affiliation: *Department of Neurological Surgery †Spine Center Departments of ‡Radiology §Anaesthesiology and Pain Medicine ∥Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Dong Kwang
authors.initials: DK
authors.lastname: Seo
authors.forename: Moon Kyu
authors.initials: MK
authors.lastname: Kim
authors.forename: Soo Jung
authors.initials: SJ
authors.lastname: Choi
authors.forename: Jun Young
authors.initials: JY
authors.lastname: Sohn
authors.forename: Young Ki
authors.initials: YK
authors.lastname: Kim
authors.forename: Eui Kyun
authors.initials: EK
authors.lastname: Jeong
authors.forename: Jung-Ki
authors.initials: JK
authors.lastname: Ha
authors.forename: Chung Hwan
authors.initials: CH
authors.lastname: Kim
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult