J Korean Neurosurg Soc.  2014 Jan;55(1):12-17. 10.3340/jkns.2014.55.1.12.

Anterior Cervical Discectomy and Fusion Using a Double Cylindrical Cage versus an Anterior Cervical Plating System with Iliac Crest Autografts for the Treatment of Cervical Degenerative Disc Disease

• Kim SJ
• Kim SD

• KMID: 2191034
• DOI: http://doi.org/10.3340/jkns.2014.55.1.12

Abstract

OBJECTIVE
Anterior cervical discectomy and fusion (ACDF) is often complicated by subsidence, pseudoarthrosis, kyphosis, and graft donor site morbidities. To decrease the occurrence of these complications, various types of cages have been developed. We designed this retrospective study to analyze and compare the efficacy and outcomes of ACDF using double cylindrical cages (DCC) (BK Medical, Seoul, Korea) versus an anterior cervical plating system with autogenous iliac crest grafts.
METHODS
Forty-eight patients were treated with autograft and plating (plate group), and 48 with DCC group from October 2007 to October 2011. We analyzed construct length, cervical lordotic curvarture, the thickness of the prevertebral soft tissue, segmental instability, and clinical outcomes.
RESULTS
There were no significant differences between the two groups with regard to the decrease in construct length or cervical lodortic curvature at the 3-, 6-, and 12-month follow-ups. The prevertebral soft tissue was thinner in the DCC group than the plate group immediately after surgery and at the 3-, 6-, and 12-month follow-ups. The difference in interspinous distance on flexion-extension was shorter in the plate group than the DCC group at the 3- and 6-month follow-ups. However, there was no significant difference in this distance between the two groups at the 12-month follow-up.
CONCLUSION
A double cylindrical cage is a good alternative for fusion in patients with cervical degenerative diseases; the surgical method is relatively simple, allows good synostosis, has less associated prevertebral soft tissue swelling, and complications associated with autografting can be avoided.

Keyword

Cylindrical cage; ACDF; Subsidence; Fusion

MeSH Terms

Autografts*
Diskectomy*
Follow-Up Studies
Humans
Kyphosis
Methods
Pseudarthrosis
Retrospective Studies
Seoul
Synostosis
Tissue Donors
Transplantation, Autologous
Transplants

Figure

• 

  Fig. 1 A : Double cylindrical cage (DCC). B : Intraoperative picture after cage placement. C and D : Anteroposterior and lateral radiographs following anterior cervical discectomy and fusion using DCC.

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  Fig. 2 A : The construct length was measured as the distance between the middle margin of the upper end plate of the upper vertebra and the middle margin of the lower end plate of the lower vertebra. B : The lordotic curvature was measured by Profeta's method. C : The thickness of the prevertebral soft tissue was measured as the distance between the soft tissue shadow and the anterior margin of the lower endplate of the caudal vertebra. D : Segmental instability was measured as the difference of the interspinous distance on the flexion and extension radiographs.

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