Lightning Podiums: Cervical Degenerative - Room 802A
Presented by: J. Garber
(1) Western Regional Brain and Spine, Las Vegas, NV, United States
Background: Although extremely effective at a single level, anterior cervical discectomy and fusion (ACDF) with an anterior cervical plate (ACP) for multiple level fusion is associated with postoperative complications commonly attributed to wide operative exposure, plate profiles anterior to the vertebral column, and potential for kyphosis over a long construct. Alternatively, cervical integrated interbody fusion with compressive/lag fixation has emerged as a promising alternative to allow for smaller exposure, no anterior profile, and level specific sagittal alignment. The purpose of the study was to retrospectively evaluate a patients treated from single to multiple levels with integrated interbody fusion by a single surgeon.
Methods: A total of 200 patients consecutive patients with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathy were surgically treated with a cervical integrated interbody fusion device with compressive fixation (STALIF C, Centinel Spine, West Chester, PA) between the C3-C7 levels. Patients were assessed pre-operatively and post-operatively at 6 weeks, 3, and 6 months. Patients were evaluated for patient-derived outcome measures, and radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment, and fusion status), and device-related complications.
Results: The average age at time of surgery was 53.4 ± 10.7 years. All had failed conservative treatment. Seventy-four patients underwent the procedure at single level, 66 patients at 2-levels, 40 patients at 3-levels, and 15 patients at 4-levels, 5 patients at 5-levels, and 1 patient at 6-levels. Blood loss was minimal and no intra-operative complications were recorded. Hospital stay was minimal with 92% of patients being released the following day. Radiographic results showed lordosis was maintained in the global spine and bone formation was present in the inner column of the device. Overall fusion rate was 92%. The revision surgery patients showed better alignment than pre-operatively with static plates. There were no signs of heterotopic ossification of the ligaments or vertebral bodies. At 6 months, none of the patients reported chronic dysphagia. There were no device failures out to last follow-up. 86% of patients were able to return to the same level of work as prior to surgery.
Discussion: For patients undergoing single and multi-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. Previously, studies with static integrated interbody fixation devices have not reported as well as ACP with regards to fusion and clinical outcomes. The benefit of a lag design to provide better fixation and more accurate maintenance of the lordotic curve of the cervical spine was seen in our series. Patients reported they were well satisfied with their results and experienced significant pain relief. The opportunity to either revise a previous ACDF with ACP or add to a pre-existing ACDF offers greater flexibility to treat the pathology at the index level rather than approach as a global construct.