General Session: Cervical Degenerative
Presented by: S. Overley - View Audio/Video Presentation (Members Only)
S. Overley(1), R. Merrill(1), D. Leven(1), J. Meaike(1), A. Kumar(1), S. Qureshi(1)
(1) Icahn School of Medicine at Mount Sinai, New York, NY, United States
Introduction: ACDF is a widely utilized procedure to treat degenerative conditions of the cervical spine. Anterior plates provide added stability, but are commonly associated with dysphagia. Stand-alone, zero-profile cages anchor directly into adjacent vertebrae to reduce the bulk of instrumentation and associated esophageal irritation. The literature is divided, though, as to whether the stand-alone cages are as efficacious and reduce esophageal related complications compared to anterior cervical plates. Our objective with this retrospective matched cohort study was to compare perioperative characteristics between similar cohorts treated with either a stand-alone cage or an anterior cervical plate during anterior cervical discectomy and fusion (ACDF).
Methods: We reviewed 40 adult patients who received a stand-alone cage for elective ACDF between 2012 and 2016, and based on demographic and operative conditions matched them with 40 patients who received an anterior cervical plate during the same time period. We statistically compared operative time, length of stay, proportion of ambulatory cases, overall complications necessitating a trip to the ED, re-admission, or re-operation related to index procedure with further analysis of the subset of those chief complaints related specifically to dysphagia, dysphonia or airway compromise between the two cohorts.
Results: There were 21 women and 19 men in the plate cohort with average ages of 53 years ± 12 and 20 women and 20 men in the stand-alone group with an average age of 52 years ± 11. With no statistical difference in total number, the plate group experienced 4 short-term (within 90 days of discharge) complications, including 3 patients who visited the emergency department for dysphagia and 1 patient who visited the emergency department for severe back and shoulder pain, while the stand-alone group experienced 0 complications. There was no significant difference in operative time between the stand-alone group (75.35min.) and the plate group (81.35min.)(p=0.37). There was a significant difference between the proportion of ambulatory cases in the stand-alone group (25) and the plate group (6) (p< 0.0001).
Conclusion: Our results demonstrate that stand-alone cages have fewer complications compared to anterior plating, with a lower trend of incidence of postoperative dysphagia. The two devices are equal regarding operative time, but the stand-alone cages offer the advantage of sending patients home ambulatory after ACDF surgery.