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      A Prospective Study of Clinical and Radiological Outcomes of Zero-Profile Cage Screw Implants for Single-Level Anterior Cervical Discectomy and Fusion: Is Segmental Lordosis Maintained at 2 Years?

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          Abstract

          Study Design

          Prospective cohort study.

          Purpose

          To study clinicoradiological parameters of zero-profile cage screw used for anterior cervical discectomy and fusion (ACDF).

          Overview of Literature

          Radiological parameters of various implants used for ACDF are available, but those for zero-profile cage are sparse.

          Methods

          Patients with unilateral intractable brachialgia due to single-level cervical disc prolapse between April 1, 2011 and March 31, 2014 were included. Clinical assessment included arm and neck pain using visual analogue score (VAS) and neck disability index (NDI) scores. Radiological assessment included motion segment height, adjacent disc height (upper and lower), segmental and cervical lordosis, implant subsidence, and pseudoarthrosis. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months.

          Results

          Thirty-four patients (26 males, 8 females) aged 30–50 years (mean, 42.2) showed excellent clinical improvement based on VAS scores (7.4–0 for arm and 2.0–0.6 for neck pains). Postoperative disc height improved by 11.33% ( p<0.001), but at 2 years, the score deteriorated by 7.03% ( p<0.001). Difference in the adjacent segment disc height at 2 years was 0.08% ( p=0.8) in upper and 0.16% ( p<0.001) in lower disc spaces. Average segmental lordosis achieved was 5.59° ( p<0.001) from a preoperative kyphosis of 0.88°; at 2 years, an average loss of 7.05° ( p<0.001) occurred, resulting in an average segmental kyphosis of 1.38°. Cervical lordosis improved from 11.59° to 14.88° ( p=0.164), and at 2 years, it progressively improved to 22.59° ( p<0.001). Three patients showed bone formation and two mild protrusion of the implant at 2 years without pseudoarthrosis/implant failure.

          Conclusions

          The zero-profile cage screw device provides good fusion and cervical lordosis but is incapable of maintaining the segmental lordosis achieved up to a 2-year follow-up. We also recommend caution when using it in patients with small vertebrae.

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          Long-term follow-up after interbody fusion of the cervical spine.

          Jan Goffin, Nicolaas Vantomme, Frank Calenbergh … (2004)
          The aim of this work was to add to the body of data on the frequency and severity of degenerative radiographic findings at adjacent levels after anterior cervical interbody fusion and on their clinical impact and to contribute to the insights about their pathogenesis. One hundred eighty patients who were treated by anterior cervical interbody fusion and who had a follow-up of >60 months were clinically and radiologically examined by independent investigators. For all patients, the long-term Odom score was compared with the score as obtained 6 weeks after surgery. For myelopathic cases, both the late Nurick and the Odom score were compared with the initial postoperative situation. For the adjacent disc levels, a radiologic "degeneration score" was defined and assessed both initially and at long-term follow-up. At late follow-up after anterior cervical interbody fusion, additional radiologic degeneration at the adjacent disc levels was found in 92% of the cases, often reflecting a clinical deterioration. The severity of this additional degeneration correlated with the time interval since surgery. The similarity of progression to degeneration between younger trauma patients and older nontrauma patients suggests that both the biomechanical impact of the interbody fusion and the natural progression of pre-existing degenerative disease act as triggering factors for adjacent level degeneration.
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            The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion.

            Kyung Bok Lee, Seung-Hoon Song, Yoo Kyung Song … (2009)
            STUDY DESIGN.: Retrospective study. OBJECTIVE.: To compare the efficacy of anterior cervical discectomy and fusion with cage alone (ACDF-CA) with cage and plate construct (ACDF-CPC) in regards to fusion rate, radiologic and clinical outcomes. SUMMARY OF BACKGROUND DATA.: ACDF-CA has shown good results; however, debate exists regarding the high rate of complications such as pseudarthrosis, subsidence, and local kyphosis. In an attempt to avoid these complications, the authors have performed ACDF with cage and plate construct (ACDF-CPC). METHODS.: A total of 78 consecutive patients who underwent 1- or 2-level ACDF-CA or ACDF-CPC suffering from cervical radiculopathy were divided into 2 groups; Group A (n = 38) underwent ACDF-CA; Group B (n = 40) underwent ACDF-CPC. Fusion rate, segmental kyphosis, disc height, and subsidence rate were assessed by radiographs. Clinical outcomes were assessed using Robinson criteria. RESULTS.: Solid fusion was achieved in 78.9% (30/38) of subjects in group A compared to 97.5% (39/40) of subjects in group B (P = 0.01). Segmental kyphosis was noted in 42.1% (16/38) in group A compared with 10% (4/40) in group B (P < 0.01). There was a significant decrease in disc height in group A compared to group B (P < 0.05). Subsidence occurred in 32.3% (19/59 levels) of group A compared with 9.7% (6/62 levels) of group B (P < 0.01). Clinical outcomes were similar for both treatment groups. The pseudarthrosis rate in group A was higher than that in group B (P = 0.01). Revision surgery was required in 10.5% (4/38) of group A, whereas none of group B required reoperation (P < 0.01). CONCLUSION.: The use of cage and plate construct in 1- or 2-level ACDF results in a more lordotic alignment, an increased disc height, a higher fusion rate, a lower subsidence rate, and a lower complication rate than that of cage alone; however, there is no significant difference in clinical outcome between groups.
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              Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study.

              W Brodner, Thomas R Highland, Wai Mun Yue (2005)
              A retrospective review. To determine the clinical and radiologic outcomes beyond 5 years after anterior cervical discectomy and fusion with allograft and plating. Anterior cervical discectomy and fusion is commonly performed for cervical disc disease. The routine use of allografts and plating, though increasing in popularity, has not been well studied for long-term results and complications. Seventy-one patients who had anterior cervical discectomy and fusion with allograft and plating an average of 7.2 years prior responded to an invitation to return for a follow-up clinical and radiographic review. At final review, symptom resolution remained greater than 82% and fusion occurred in 92.6% of the disc spaces operated on. No graft extrusion or migration occurred. Based on our strict criteria, the rates of collapse and subsidence were high, at 47.9% (34 patients) overall. However, in only 6 patients (8.5%) did segmental kyphosis result, none of whom required any revision surgery in the follow-up period. Implant complications occurred in 7 patients (9.9%), none of whom required revision surgeries. Adjacent level degeneration occurred in 52 patients (73.2%). Further cervical spine surgeries were required in 14 patients (19.7%), 2 for inadequate decompression, and 12 for adjacent level disease. Segmental and global cervical lordosis was restored and maintained by the surgery over the study period. The use of allografts and plate fixation in combination for anterior cervical discectomy and fusion does not compromise the radiologic and clinical outcomes while providing the advantages of donor site morbidity elimination, restoration of cervical segmental lordosis, and not requiring postoperative immobilization.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Asian Spine J
                Journal ID (iso-abbrev): Asian Spine J
                Journal ID (publisher-id): ASJ
                Title: Asian Spine Journal
                Publisher: Korean Society of Spine Surgery
                ISSN (Print): 1976-1902
                ISSN (Electronic): 1976-7846
                Publication date (Print): April 2017
                Publication date (Electronic): 12 April 2017
                Volume: 11
                Issue: 2
                Pages: 264-271
                Affiliations
                [1 ]Park Clinic, Kolkata, India.
                [2 ]Ortho One Orthopaedic Subspecialty Centre, Coimbatore, India.
                Author notes
                Corresponding author: Saumyajit Basu. Park Clinic, 4, Gorky Terrace, Kolkata 700017, India. Tel: +913322801986, saumyajit2016@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-7979-8745
                Article
                DOI: 10.4184/asj.2017.11.2.264
                PMC ID: 5401841
                SO-VID: d00152b4-4424-4ce8-9d46-9cdc516f6a21
                Copyright © Copyright © 2017 by Korean Society of Spine Surgery
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 April 2016
                Date revision received : 11 September 2016
                Date accepted : 27 September 2016
                Categories
                Subject: Clinical Study

                ScienceOpen disciplines: Orthopedics
                Keywords: zero profile,cage screw,anterior cervical discectomy and fusion,lordosis,anterior cervical discectomy
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: zero profile, cage screw, anterior cervical discectomy and fusion, lordosis, anterior cervical discectomy

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