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2016, Volume 7, Number 3, Page(s) 210-217
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Outcomes Evaluation of Zero-Profile Devices Compared to Stand-Alone PEEK Cages for the Treatment of Three- and Four-Level Cervical Disc Disease
Hazem Mashaly1,2, Khaled MF Saoud2, Hatem Sabry2,3, Hasan Jalalod’din2, Erin E. Paschel1, Peter C. Gerszten1
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, UPMC Health System, Pittsburgh, Pennsylvania
2Department of Neurological Surgery, Ain Shams University, Cairo, Egypt
3Neurosurgery Department, Saudi German Hospital, Cairo, Egypt
Keywords: Anterior cervical discectomy and fusion, 3-level, 4-level, cervical spine, fusion

AIM: Anterior cervical discectomy and fusion (ACDF) is a well-accepted treatment option for patients with cervical spine disease. Three- and 4-level discectomies are known to be associated with a higher complication rate and lower fusion rate than single level surgery. This study was performed to evaluate and compare zeroprofile fixation and stand-alone PEEK cages for 3- and 4-level ACDF.

MATERIAL and METHODS: Two cohorts of patients who underwent ACDF for the treatment of three- and four-level disease were compared. Thirty-three patients underwent implantation of zero-profile devices that included titanium screw fixation (Group A). Thirty-five patients underwent implantation of stand-alone PEEK cages without any form of screw fixation (Group B).

RESULTS: In Group A, 27 patients underwent a 3-level and 6 patients a 4-level ACDF, with a total of 105 levels. In Group B, 30 patients underwent a 3-level and 5 patients underwent a 4-level ACDF, with a total number of 110 levels. In Group A the mean preoperative Visual Analog Scale score (VAS) for arm pain was 6.4 (range 3-8), and the mean postoperative VAS for arm pain decreased to 2.5 (range 1-7). In Group B, the mean preoperative VAS of arm pain was 7.1 (range 3-10), and the mean postoperative VAS of arm pain decreased to 2 (range 0-4). In Group A, 4 patients (12%) developed dysphagia, and in Group B, 3 patients (9%) developed dysphagia.

CONCLUSIONS: This study found zero-profile instrumentation and PEEK cages to be both safe and effective for patients who underwent 3- and 4-level ACDF, comparable to reported series using plate devices. Rates of dysphagia for the cohort were much lower than reports using plate devices. Zero-profile segmental fixation devices and PEEK cages may be considered as viable alternatives over plate fixation for patients requiring multilevel anterior cervical fusion surgery.

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