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2016, Volume 7, Number 3, Page(s) 201-209
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Anterior Cervical Discectomy with Stand Alone PEEK Cage for Management of 3 and 4 Level Degenerative Cervical Disc Disease
Khaled MF Saoud, Hazem A Mashaly, Hatem Sabry
Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
Keywords: ACDF, multilevel fusion, normal BMD, nurik score, stand-alone cages, VAS

AIM: The aim of this study was to evaluate the efficacy of cage-assisted fusion in three and four level cervical arthrodesis without additional anterior plating in patients with normal BMD. We hypothesized that omitting the use of long anterior cervical plate in multi-level ACDF will simplify the surgery, reduce the surgical time, avoid excessive and prolonged retraction on esophagus and carotids, and will also reduce the potential complications of application of long anterior cervical plate in selected patients. We also thought that the success of stand-alone cage would reduce the cost of the surgery, which is crucial in low-income countries.

MATERIAL and METHODS: This prospective case series study included 30 patients diagnosed and treated for multilevel (at least 3 levels) cervical disc prolapse presented by either radiculopathy and/or myelopathy operated by anterior cervical micro-discectomy and stand-alone cage fusion. These cases were treated at Ain Shams University hospitals and Arab Contractors Medical Center between 2008 and 2011.

RESULTS: This study included 30 patients; 27 were males (90%) and 3 were females (10%). The presenting symptoms in order of frequency were neck pain (100%) of the cases, followed by radicular pains (70%) and Myelopathy (40%). The mean age of the patients at the time of surgery was 52.23 (minimum 42 and maximum 70 years). 28 patients in our series we operated for three levels (93.4%), and 2 cases we operated for four levels (6.6%). There has been no operative related mortality or morbidity in our series. All the cases were discharged on the first or second postoperative day. We had statistically significant reduction of VAS of arm pains in the immediate postoperative periods. This statistically significant reduction was maintained through the follow up period. There has not been significant correlation between the VAS preoperatively and immediately postoperatively. There has been statistically significant reduction in the VAS of neck pain starting from the third month postoperatively. We had statistically significant reduction of the Nurick score for patients presenting with myelopathy postoperatively. We had solid fusion in 28 patients (93.3 %), and there was no fusion in 2 patients (6.7%). Three cases (10%) needed reoperation. One case operated originally for C3-4, 4-5 and 5-6 disc disease needed reoperation for adjacent segment degeneration at C6-7. Another case developed postoperative discitis after C4-5, 5-6, 6-7 ACDF. A third case developed cage subsidence due to excess removal of the endplate and needed reoperation for corpectomy and fusion and fixation.

CONCLUSIONS: We recommend that ACDF with stand-alone cage fusion is a safe and effective measure in treatment of 3 or 4 level disc disease with no need of cervical plating in selected patients. We believe that BMD assessment should be added to the routine investigations of patients undergoing fusion surgery as it may change surgical planning.

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