A radiographic follow-up study of stand-alone-cage and graft-plate constructs for single-level anterior cervical discectomy and fusion

Structural Allograft Versus Mechanical Interbody Devices Augmented With Osteobiologics in Anterior Cervical Discectomy and Fusion: A Systematic Review

STUDY DESIGN

Systematic Literature Review.

OBJECTIVE

Perform a systematic review evaluating postoperative fusion rates for anterior cervical discectomy and fusion (ACDF) using structural allograft vs various interbody devices augmented with different osteobiologic materials.

METHODS

Comprehensive literature search using PubMed, Embase, The Cochrane Library, and Web of Science was performed. Included studies were those that reported results of 1-4 levels ACDF using pure structural allograft compared with a mechanical interbody device augmented with an osteobiologic. Excluded studies were those that reported on ACDF with cervical corpectomy; anterior and posterior cervical fusions; circumferential (360° or 540°) fusion or revision ACDF for nonunion or other conditions. Risk of bias was determined using the Cochrane review guidelines.

RESULTS

8 articles reporting fusion rates of structural allograft and an interbody device/osteobiologic pair were included. All included studies compared fusion rates following ACDF among structural allograft vs non-allograft interbody device/osteobiologic pairs. Fusion rates were reported between 84% and 100% for structural allograft, while fusion rates for various interbody device/osteobiologic combinations ranged from 26% to 100%. Among non-allograft cage groups fusion rates varied from 73-100%. One study found PEEK cages filled with combinations of autograft, allograft, and demineralized bone matrix (DBM) to have an overall fusion rate of 26%. In one study comparing plate and zero-profile constructs, there was no difference in fusion rates for two-level fusions.

CONCLUSION

There was limited data comparing fusion outcomes of patients undergoing ACDF using structural allograft vs interbody devices augmented with osteobiologic materials to support superiority of one method.

Anterior Cervical Spine Surgery Complicated With Dysphagia

Anterior cervical spine surgery is a common type of neck surgery in orthopaedics. Swallowing disorder is one of the most common complications after surgery. It is characterized by food entering the esophagus from the mouth through the pharynx. The process of reaching the stomach is hampered and leads to increases in a range of risk factors that affect the health of the patient. This article reviews relevant literature reports from recent years retrieved from various national and international medical databases, aiming to find more economical, effective, and simple perioperative nursing strategies for patients with cervical anterior surgery through evidence-based thinking and methods, with the aim of developing a personalized care model that is easy to implement and has a long-lasting effect and a wide range of rehabilitation benefits to better serve patients.

Comparison of Clinical and Radiographic Outcomes After Standalone Versus Cage and Plate Constructs for Anterior Cervical Discectomy and Fusion

BACKGROUND

Anterior cervical discectomy and fusion (ACDF) has conventionally been performed using an allograft cage with a plate-and-screw construct. Recently, standalone cages have gained popularity due to theorized decreases in operative time and postoperative dysphagia. Few studies have compared these outcomes. Here, we directly compare the outcomes of plated versus standalone ACDF constructs.

METHODS

A single-center retrospective review of patients undergoing ACDF after June 2011 with at least 6 months of follow up was conducted. Clinical outcomes were analyzed and compared between standalone and plated constructs. Multivariate regression analysis of the primary outcome, need for revision surgery, as well as several secondary outcomes, procedure duration, estimated blood loss (EBL), length of hospital stay, disposition, and incidence of dysphagia, hoarseness, or surgical site infection, was completed.

RESULTS

A total of 321 patients underwent ACDF and met inclusion-exclusion criteria, with mean follow-up duration of 20 months. Forty-six (14.3%) patients received standalone constructs, while 275 (85.7%) received plated constructs. Fourteen (4.4%) total revisions were necessary, 4 in the standalone group and 10 in the plated group, yielding revision rates of 8.7% and 3.6%, respectively (P = .125). Mean EBL was 98 mL in the standalone group and 63 mL in the plated group (P = .001). Mean procedure duration was 147 minutes in the standalone group and 151 minutes in the plated group (P = .800). Mean hospital stay was 3.6 days in the standalone group and 2.5 days in the plated group (P = .270). There was no significant difference in incidence of dysphagia (P = .700) or hoarseness (P = .700).

CONCLUSIONS

Standalone ACDF demonstrates higher, but not statistically significant, revision rates than plate-and-screw constructs, without the hypothesized decreased incidence of dysphagia or hoarseness and without decreased procedure duration or EBL. Surgeons may consider limiting use of these constructs to cases of adjacent segment disease. Larger studies with longer follow up are necessary to make more definitive conclusions.

LEVEL OF EVIDENCE

4.

CLINICAL RELEVANCE

This study will help spine surgeons decide between using standalone or cage-and-plate constructs for ACDF.

Comparison of stand-alone cage and cage-with-plate for monosegmental cervical fusion and impact of virtual reality in evaluating surgical results

OBJECTIVES

After ventral decompression of monosegmental cervical spondylotic stenosis, a stand-alone cage (SC) or cage-with-plate (CP) can be inserted for fusion. Postoperative radiological evaluation can be achieved using different imaging modalities. We retrospectively compared complications, as well as clinical and radiological outcomes for both fusion techniques, and analyzed the possible role of virtual reality (VR) in evaluating the postoperative results.

PATIENTS AND METHODS

One hundred seventeen patients were included (SC/CP: 54/63). Complications, as well as clinical and radiological outcomes of both fusion techniques were compared. Computed tomography (CT) scans were visualized via VR to measure the smallest cross-sectional area of the intervertebral neuroforamen in the lateral resection region, and to assess the degree of the intersegmental ossification.

RESULTS

There were no significant differences between the two fusion techniques regarding perioperative complication rates, fusion rates, or pain parameter (visual analogue scale (VAS) of arm pain, neck disability index). However, advantages regarding subsidence, kyphosis, and VAS of neck pain were found when using the CP versus SC. Using the VR technique, there was no significant difference between the two fusion techniques in the mean size of the cross-sectional area at the end of follow-up.

CONCLUSION

Due to the long-term advantages of CP fusion, we prefer a monosegmental cervical spinal fusion using CP. Reconstruction of postsurgical two-dimensional CT images into three-dimensional images, and the spatial and anatomical presentation in VR models, improved the evaluation of these postoperative results.