J Korean Neurosurg Soc.  2016 Jul;59(4):385-391. 10.3340/jkns.2016.59.4.385.

Long-Term Follow-Up Results of Anterior Cervical Inter-Body Fusion with Stand-Alone Cages

• Kim WB
• Hyun SJ
• Choi H
• Kim KJ
• Jahng TA
• Kim HJ

• KMID: 2315975
• DOI: http://doi.org/10.3340/jkns.2016.59.4.385

Abstract

OBJECTIVE
The purpose of this study was to evaluate long-term follow-up radiologic/clinical outcomes of patients who underwent anterior cervical discectomy and inter-body fusion (ACDF) with stand-alone cages (SAC) in a single academic institution.
METHODS
Total 99 patients who underwent ACDF with SAC between February 2004 and December 2012 were evaluated retrospectively. A total of 131 segments were enrolled in this study. Basic demographic information, radiographic [segmental subsidence rate, fusion rate, C2-7 global angle, and segmental angle changes)/clinical outcomes (by Odom's criteria and visual analog score (VAS)] and complications were evaluated to determine the long-term outcomes.
RESULTS
The majority were males (55 vs. 44) with average age of 53.2. Mean follow-up period was 62.9 months. The segmental subsidence rate was 53.4% and fusion rate was 73.3%. In the subsidence group, anterior intervertebral height (AIH) had more tendency of subsiding than middle or posterior intervertebral height (p=0.01). The segmental angle led kyphotic change related to the subsidence of the AIH. Adjacent segmental disease was occurred in 18 (18.2%) patients. Total 6 (6%) reoperations were performed at the index level. There was no statistical significance between clinical and radiological outcomes. But, overall long-term clinical outcome by Odom's criteria was unsatisfactory (64.64%). The neck and arm VAS score were increased by over time.
CONCLUSION
Long-term outcomes of ACDF with SAC group were acceptable but not satisfactory. For optimal decision making, more additional comparative long-term outcome data is needed between ACDF with SAC and ACDF with plating.

Keyword

Anterior cervical discectomy and fusion; Stand-alone cage; Subsidence; Long-term outcomes; Intervertebral height; Odom's criteria

MeSH Terms

Arm
Decision Making
Diskectomy
Follow-Up Studies*
Humans
Male
Neck
Retrospective Studies

Figure

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  Fig. 1 A : Preoperative cervical spine lateral radiograph. B, C, and D : Postoperative cervical spine lateral radiograph show subsidence (B : Immediate postoperative standing radiograph, C : 1 month postoperative standing radiograph, D : Ultimate follow-up period radiograph).

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  Fig. 2 A, B, and C : Preoperative, immediate standing postoperative, 1 month, 1 year, 2 year postoperative, and ultimate follow-up AIH, MIH, and PIH (anterior, middle, and posterior intervertebral height) change between S- and NS-group. S : subsidence, NS : non-subsidence, AIH : anterior intervertebral height, MIH : middle intervertebral height, PIH : posterior intervertebral height.

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  Fig. 3 The preoperative, 1 month, 1 year, and 2 year after surgery, and ultimate follow-up segmental angle change between S- and NS-group. Negative value means lordotic segmental angle. S : subsidence, NS : non-subsidence.

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  Fig. 4 A : The preoperative, 1 year, 2 year after surgery, and the ultimate follow-up neck VAS change between S- and NS-group. B : The preoperative, 1 year, 2 year after surgery, and the ultimate follow-up arm VAS change between S- and NS-group. S : subsidence, NS : non-subsidence, VAS : visual analog scale.

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  Fig. 5 The preoperative, 1 year, 2 year after surgery, and the ultimate follow-up neck VAS vs. arm VAS change following over time in all ACDF with SAC patients. VAS : visual analog scale, ACDF : Anterior cervical discectomy and inter-body fusion, SAC : stand-alone cages.

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