Comparison of 5 Year Outcomes in Anterior Cervical Discectomy and Fusion with Stand Alone Interbody Technique Versus Conventional Cage-Plate Technique in Cervical Spondylotic Myelopathy
Neurosurgery Resident University Of Virginia Charlottesville, Virginia, United States
Introduction: Anterior Cervical Discectomy and Fusion (ACDF) conventional cage-plate is associated with postoperative dysphagia, hoarseness, and infrequently, plate migration. To minimize these risks, interbody cages without the use of plates have been developed. Differences in patient reported outcome measures (PROMs) and complications, such as adjacent segment disease (ASD) remain unclear. The objective of this study is to determine the long term clinical outcomes of patients undergoing ACDF for cervical spondylotic myelopathy (CSM).
Methods: A retrospective analysis of the prospectively collected quality outcomes database (QOD) of a high enrolling private practice in the QOD Study Group was performed. Patients with CSM who underwent ACDF were isolated. Patient baseline characteristics and patient reported outcome measures (PROMs) were collected.
Results: A total of 39 patients were isolated. Standard cage-plate technique was used in 31 patients and interbody cages were used in 8. There were no significant variations in baseline patient comorbidities, disability, underlying pathology, or the presence of listhesis between the two groups. There was no significant difference in the number of levels treated between cage-plate and interbody cages (1.7 v. 2.3, p=0.11). No significant differences were observed in patient reported outcomes at 12 or 24 month interval follow ups. At 60 months postoperatively the interbody cage cohort reported lower neck pain (2.2 v. 0.7, p=0.01) and NDI (0.7 v. 8.3, p< 0.0001). Higher mJOA was also seen in the interbody cage group (16.0 v. 14.4, p< 0.0001). There were no differences in satisfaction between the two groups. At 5 year follow-up there was one instance of ASD in the cage-plate group and none in the interbody only group.
Conclusion : This study finds no significant variation in ASD or clinical outcomes between conventional cage-plate and stand alone interbody up to 24 month follow up. Higher disability in the cage-plate group at 60 months likely stems from a smaller patient cohort in this group. However, these differences warrant further evaluation with larger patient cohorts.