Retrospective Data Analysis of Anterior Cervical Discectomies and Fusion Without Plate and Screws

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Surgical intervention in cervical disease can relieve neurological symptoms and improve life quality. This study aimed to analyse retrospective data of microscope-assisted anterior cervical discectomy and fusion (ACDF) surgeries. The retrospective study was carried out at the ORTO clinic, Rīga, Latvia, from 2013 to 2017. Data from 198 patients were extracted retrospectively. Data on patient gender, age, diagnosis, extent of operation, type of cage and the overall height of the implants were used. Comparative analysis was carried out with the SPSS 22 software. P < 0.05 represented statistical significance. During the study period, 198 elective ACDF were carried out with increasing number of surgeries: 25 cases in 2013, 43 in 2014, 38 in 2015, 44 in 2016, and 48 in 2017. ACDF were significantly more often performed for females (n = 117, 59%) compared to males (n = 81, 41%; p < 0.003). Women were older with an average age of 50 ± 1 years than men (age 46 ± 1; p = 0.007). The mean surgery time was 1.5 ± 1 hours and the mean hospitalisation time was 3 ± 1 days. Four types of cages were used in similar number of operation: Cervios Peek Chronos C (24%), Syncage C (21%), EIT 3D print (29%), Cervios C Peek (26%); p = 0.2, regardless of patient age or gender. Most often, in 98 cases, the overall height of implants was 6–10 mm. The maximal height was 22 mm, where two patients underwent three-level, and one had a four-level discectomy. The most prevalent disc lesion levels were C5/6 and C6/7, followed by C4/5 and C3/4. One- and two-level discectomies were performed in similar numbers: 95 and 81 cases. However, only 20 patients underwent three level and two patients had four level discectomies in 2016 and 2017. Two level discectomy at C5/6, C6/7 was carried out significantly more often for women (55 vs. 26; p = 0.01), and for men 1-level lesion was more common in C6/7; p = 0.04. The overall incidence of cage subsidence was 5.5%, and the highest incidence was 24% when a Syncage C was used. The ACDF appears to be performed increasingly more often, particularly, in females. The most frequent operation was in one or two cervical levels; including level C6/7 in both genders. In the last years, three- and four-level cervical discectomies have become one of the surgical opportunities. Choice of cage was not influenced by patient gender and age, while cage biophysical and biochemical properties may influence the choice.

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  • Bakhsheshian J. Mehta V. A. Liu J. C. (2017). Current diagnosis and management of cervical spondylotic myelopathy. Global Spine J. 7 (6) 572–586.

  • Chen Y. Lu G. Wang B. Li L. Kuang L. (2016). A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetherether ketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: A retrospective study with 2-year follow-up. Eur. Spine J. 25 (7) 2255–2262.

  • Chong E. Pelletier M. H. Mobbs R. J. Walsh W. R. (2015). The design evolution of interbody cages in anterior cervical discectomy and fusion: A systematic review. BMC Musculoskelet. Disord. 16 99.

  • Fountas K. N. Kapsalaki E. Z. Nikolakakos L. G. Smisson H. F. Johnston K. W.. Grigorian A. A. Lee G. P. Robinson Jr J. S. (2007). Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32 (21) 2310–2317.

  • Fouyas I. P. Sandercock P. A. Statham P. F. Nikolaidis I. (2010). How beneficial is surgery for cervical radiculopathy and myelopathy? BMJ341 c3108.

  • Hermansen A. (2015). Clinical and patient-reported outcomes after anterior cervical decompression and fusion surgery. Linköping University Medical Dissertations No. 1443.

  • Iyer S. Kim H. J. (2016). Cervical radiculopathy. Curr. Rev. Musculoskelet. Med. 9 (3) 272–280.

  • Kim H. J. Nemani V. M. Piyaskulkaew C. Vargas S. R. Riew K. D. (2016). Cervical Radiculopathy: Incidence and Treatment of 1420 Consecutive Cases. Asian Spine J.10 (2) 231–237.

  • Kim J. H. Park J. Y. Yi S. Kim K. H. Kuh S. U. Chin D. K. Kim K. S. Cho Y. E. (2015). Anterior cervical discectomy and fusion alters whole-spine sagittal alignment. Yonsei Med. J. 56 (4) 1060–1070.

  • Kurtz S. M. Devine J. N. (2007). PEEK biomaterials in trauma orthopedic and spinal implants. Biomaterials 28 (32) 4845–4869.

  • Montgomery D. M. Brower R. S. (1992). Cervical spondylotic myelopathy. Clinical syndrome and natural history. Orthop. Clin. North. Amer. 23 (3) 487–493.

  • Moussa A. Tanzer M. Pasini D. (2018). Cervical fusion cage computationally optimized with porous architected Titanium for minimized subsidence. J. Mech. Behav. Biomed. Mater. 85 134–151.

  • Neill K. O. (2016). ACDF: Anterior cervical discectomy and fusion. Spine-health Nov. 14.

  • Nikolaidis I. Fouyas I. P. Sandercock P. A. Statham P. F. (2010). Surgery for cervical radiculopathy or myelopathy. Cochrane Database Syst. Rev. No. 1 CD001466.

  • Noordhoek I. Koning M. T. Jacobs W. C. H. Vleggeert-Lankamp C. L. A. (2018). Incidence and clinical relevance of cage subsidence in anterior cervical discectomy and fusion: A systematic review. Acta Neurochir (Wien) 160 (4) 873–880.

  • Portnoy H. D. (2001). Anterior cervical discectomy and fusion. Surg. Neurol.56 (3) 178–180.

  • Radhakrishnan K. Litchy W. J. O'Fallon W. M. Kurland L. T. (1994). Epidemiology of cervical radiculopathy. A population-based study from Rochester Minnesota 1976 through 1990. Brain 117 ( Pt 2) 325–335.

  • Rao R. (2003). Neck pain cervical radiculopathy and cervical myelopathy: Pathophysiology natural history and clinical evaluation. Instr. Course Lect. 52 479–488.

  • Shamji M. F. Massicotte E. M. Traynelis V. C. Norvell D. C. Hermsmeyer J. T. Fehlings M. G. (2013). Comparison of anterior surgical options for the treatment of multilevel cervical spondylotic myelopathy: A systematic review. Spine (Phila Pa 1976) 38 (22 Suppl 1) S195–S209.

  • Tasiou A. Giannis T. Brotis A. G. Siasios I. Georgiadis I. Gatos H. Tsianaka E. Vagkopoulos K. Paterakis K. Fountas K. N. (2017). Anterior cervical spine surgery-associated complications in a retrospective case-control study. J. Spine Surg. 3 (3) 444–459.

  • Woods B. I. Hilibrand A. S. (2015). Cervical radiculopathy: Epidemiology etiology diagnosis and treatment. J. Spinal Disord. Tech. 28 (5) E251–E259.

  • Yao Q. Yin P. Khan K. Tsai T. Y. Li J. S. Hai Y. Tang P. Li G. (2018). Differences of the morphology of subaxial cervical spine endplates between Chinese and white men and women. Biomed. Res. Int. 2018 2854175.

  • Zhou J. Li J. Lin H. Li X. Zhou X. Dong. J. (2018). A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: Minimum 3-year assessment of radiographic and clinical outcomes. Clin. Neurol. Neurosurg. 170 73–78.

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