Long-term Outcome Following Three-Level Stand-Alone Anterior Cervical Discectomy and Fusion: Is Plating Necessary?

Marios Theologou; Theologos Theologou; Nikolaos Skoulios; Maria Mitka; Nikolaos Karanikolas; Antriana Theologou; Eleftheria Georgiou; Slavisa Matejic; Christos Tsonidis

doi:10.4103/ajns.AJNS_196_19

Long-term Outcome Following Three-Level Stand-Alone Anterior Cervical Discectomy and Fusion: Is Plating Necessary?

Asian J Neurosurg. 2020 Aug 28;15(3):554-559. doi: 10.4103/ajns.AJNS_196_19. eCollection 2020 Jul-Sep.

Authors

Marios Theologou^{1

2}, Theologos Theologou³, Nikolaos Skoulios¹, Maria Mitka², Nikolaos Karanikolas¹, Antriana Theologou⁴, Eleftheria Georgiou⁵, Slavisa Matejic⁶, Christos Tsonidis¹

Affiliations

¹ Second Departments of Neurosurgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece.
² Fifth Department of Surgery, Aristotle University of Thessaloniki, Hippokration General Hospital of Thessaloniki, Greece.
³ Department of Spine Surgery, Lefkos Stavros the Athens Clinic, Athens, Greece.
⁴ School of Medicine, University of Belgrade, Belgrade, Serbia.
⁵ Pediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Greece.
⁶ Department of Neurosurgery, School of Medicine, University of Pristina Temporarily Settled in Kosovska Mitrovica, Kosovo, Serbia.

Abstract

Background: Anterior cervical discectomy with fusion (ACDF) is a proven method for the treatment of selected patients. The necessity of use of an anterior plate is controversial. The article aims to assess the fusion rates (FRs) and long-term outcomes following three-level ACDF.

Materials and methods: Data were collected from the medical records of patients operated on due to degenerative cervical disease. All patients were treated with three-level ACDF employing polyether ether-ketone cages without anterior plating. Visual analog scale (VAS), neck disability index (NDI), and plain radiographs were used in the clinical and radiological postsurgery assessment. Fusion evaluation was performed according to the <1 mm motion between spinous processes rule. Subsidence was defined as a more than 2 mm decrease in the interbody height.

Results: A total of 234 treated levels on 78 patients were assessed. The mean presurgery NDI score was 23.07 ± 4.86, with a mean disability of 46.03% ± 9.64. The mean presurgery VAS score of the neck was 7.58 ± 0.85, while VAS score of the arm was 7.75 ± 1.008. Post surgery, NDI stated no disability, while VAS score of the neck and arm showed no presence of pain. The mean FR was 19.50 ± 21.71 levels per month, with a peak from 3^rd to 6^th month. Presurgery evaluation showed 12 (15.38%) patients with a high T2 sequence signal. Magnetic resonance imaging screening detected 31 (39.24%) patients with coexisting cervical and lumbar findings. Post surgery, transient dysphagia was reported by 1 patient (1.28%), while subsidence was registered in 15 (6.41%) levels, situated in 12 patients (15.38%), most often at C_6-7 (66.6%). Clinical and radiological follow-up extended to 69.47 ± 11.45 months.

Conclusion: Multilevel stand-alone ACDF is a safe, cost-effective procedure providing favorable clinical and radiological results with minimal complications. The incidence of subsidence is usually clinically insignificant and can be decreased with a careful surgical technique.

Keywords: Anterior cervical discectomy; fusion; outcome; stand alone.