J Korean Neurosurg Soc.  2012 Mar;51(3):135-140. 10.3340/jkns.2012.51.3.135.

Radiographic Comparison of Four Anterior Fusion Methods in Two Level Cervical Disc Diseases : Autograft Plate Fixation versus Cage Plate Fixation versus Stand-Alone Cage Fusion versus Corpectomy and Plate Fixation

• Kim MK
• Kim SM
• Jeon KM
• Kim TS

• KMID: 2018185
• DOI: http://doi.org/10.3340/jkns.2012.51.3.135

Abstract

OBJECTIVE
To evaluate radiographic results of anterior fusion methods in two-level cervical disc disease : tricortical autograft and plate fixation (ACDF-AP), cage and plate fixation (ACDF-CP), stand-alone cage (ACDF-CA), and corpectomy and plate fixation (ACCF).
METHODS
The numbers of patients were 70 with a minimum 6 month follow-up (ACDF-AP : 12, ACDF-CP : 27, ACDF-CA : 15, and ACCF : 16). Dynamic simple X-ray and computed tomography were evaluated preoperatively, postoperatively, 6 month, and at the final follow-up. The fusion and subsidence rates at the final were determined, and global cervical lordosis (GCL), cervical range of motion, fused segment angle (FSA), and fused segment height (FSH) were analyzed.
RESULTS
Nonunion was observed in 4 (25%) patients with ACDF-CA, 1 (8%) patient with ACDF-AP, 1 (4%) patient with ACDF-CP. The number of loss of FSH (%) more than 3 mm were 2 patients (16%) in ACDF-AP, 3 patients (11%) in ACDF-CP, 5 patients (33%) in ACDF-CA, and 3 patients (20%) in ACCF. The GCL was decreased with ACDF-CA and increased with others. The FSA was increased with ACDF-AP, ACDF-CP, and ACCF, but ACDF-CA was decreased. At the final follow-up, the FSH was slightly decreased in ACDF-CP, ACDF-AP, and ACCF, but ACDF-CA was more decreased. Graft related complication were minimal. Screw loosening, plate fracture, cage subsidence and migration were not identified.
CONCLUSION
ACDF-CP demonstrated a higher fusion rate and less minimal FSH loss than the other fusions in two-level cervical disc disease. The ACDF-AP and ACCF methods had a better outcome than the ACDF-CA with respect to GCL, FSA, and FSH.

Keyword

Radiographic comparison; Anterior cervical fusion methods; Two-level cervical disc diseases

MeSH Terms

Animals
Follow-Up Studies
Humans
Lordosis
Range of Motion, Articular
Transplants

Figure

• 

  Fig. 1 A : Global cervical lordosis : the Cobb angle between C2 and C7 inferior endplate. B : Fused segmental angle : the angle between the lines drawn parallel to the cranial endplate of the cranial vertebrae of fused segment and the caudal endplate of the caudal vertebra of fused segment. C : Fused segmental height : the mean value of anterior and posterior vertebral body heights at the fused segments.

• 

  Fig. 2 Serial changes in the global cervical lordosis (GCL) in the four different two level anterior cervical fusion methods. ACDF : anterior cervical discectomy and fusion, ACDF-AP : ACDF using tricortical autograft and plate fixation, ACDF-CA : ACDF using stand-alone cage, ACDF-CP : ACDF using cage and plate fixation, ACCF : anterior cervical corpectomy and plate fixation.

• 

  Fig. 3 Serial changes in the fused segmental angle (FSA) in the four different two level anterior cervical fusion methods. ACDF : anterior cervical discectomy and fusion, ACDF-AP : ACDF using tricortical autograft and plate fixation, ACDF-CA : ACDF using stand-alone cage, ACDF-CP : ACDF using cage and plate fixation, ACCF : anterior cervical corpectomy and plate fixation.

• 

  Fig. 4 Serial changes of fused segmental height (FSH) in the four different two level anterior cervical fusion methods. ACDF : anterior cervical discectomy and fusion, ACDF-AP : ACDF using tricortical autograft and plate fixation, ACDF-CA : ACDF using stand-alone cage, ACDF-CP : ACDF using cage and plate fixation, ACCF : anterior cervical corpectomy and plate fixation.

• 

  Fig. 5 Serial changes of cervical range of motion (ROM) in the four different two level anterior cervical fusion methods. ACDF : anterior cervical discectomy and fusion, ACDF-AP : ACDF using tricortical autograft and plate fixation, ACDF-CA : ACDF using stand-alone cage, ACDF-CP : ACDF using cage and plate fixation, ACCF : anterior cervical corpectomy and plate fixation.

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