Multiple level Anterior Cervical Discectomy and Fusion wither to Plate or not: Pros and Cons of Both Techniques.

Introduction: Anterior cervical discectomy and fusion (ACDF) is one of the most common spine surgeries performed for diverse cervical spine diseases including disc prolapse, degenerative spondylosis, trauma, infections and/or instability. Addition of plates to cages has increasingly become a viable option for spine surgeons especially in multilevel cervical disc disease to avoid subsidence issues.

Methods: Eighty-Six patients ranging in age between 23-72 years old with mean age (47+/-16). All complaining of either radiculopathy and/or myelopathy who underwent multilevel ACDF and were followed postoperatively for at least nine months. Patients were divided into two groups: group A: 46 cases received ACDF with standalone cages while group B: 40 patients who underwent ACDF with cages and plate fixation. Clinical & radiographic outcomes were assessed. We used VAS scores and ODI to assess clinical outcomes while radiological outcomes were assessed using cervical range of motion (CROM), fusion rate, subsidence, pseudo-arthrosis, non-union, cage displacement, or cervical instability.

Results: Both techniques were comparable with no significant difference in pain relief and functional outcomes. Although the plate group was superior to standalone cage group in terms of fusion rate on 3 and 6 months postoperative, long-term outcome was almost the same. Fusion rate was nearly the same 97.5% in plate group and 95.6% with standalone cage group at 9 months of radiographic follow up. Cervical range of motion in standalone cage group was much better than plate group especially in short term follow up. There was no case showing pseudo-arthrosis, non-union, cage displacement, or cervical instability in both groups.

Conclusion : Although in short term outcomes, adding a plate was superior to the standalone cage technique in terms of fusion rate while standalone cage was superior in cervical range of motion. There was no significant difference between the two groups in long term clinical, functional and radiographic outcomes.