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Anterior discectomy and fusion with stand-alone cages safe for multi-level cervical disc disease

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GENEVA — Multi-level cervical disease can be managed effectively by combining three- or four-level anterior cervical discectomy and fusion with standalone intervertebral cages, according to a team of British spine surgeons.

John C.D. Leach, FRCS, from The John Radcliffe Hospital in Oxford, England, said that although clinical researchers have been busy comparing different techniques to treat cervical disc disease, data on both fusion and arthroplasty techniques for threeand four-level cervical disease "have been lacking." Leach's comments came in a presentation at Spine Week 2008, here.

To address this question, Leach and his team studied a select group of 18 patients, 14 who received a three-level and four who received four-level anterior cervical discectomies and fusion (ACDF) procedures with Solis cages.

They performed a majority of the procedures on the C5 and C6 discs and followed the patients for an average of 2 years. No patients had undergone prior cervical surgery.

Outcome measures included radiologic tests for disc height, kyphotic angle and fusion, as well as clinical tests (ie, Visual Analog Scores for neck and arm pain and modified Japanese Orthopaedic Association scores for myelopathy).

Results showed that there were no operative complications in any of the patients. Radiological follow-up demonstrated a significant improvement in disc space height, with the preoperative mean disc height 3.1 mm and the postoperative mean disc height 5.6 mm.

There was also no incidence of pseudarthrosis.

"We are pleased to say that no patient has required revision surgery," he said.

Leach said the ACDF approach with standalone cages is appealing because "it is safe and effective and it can be performed relatively quickly - in just 1 or 2 hours," he said. It also offers an alternative to the posterior approaches, which "have fallen out of favor lately due to ... the higher risk of kyphosis."

He added, "We are also aware that there has been some sagittal settling in a couple of patients, but we will follow these patients carefully."

For more information:

• Leach JCD, Pereira EAC, Chandran H, Cadoux-Hudson TAD. Multi-level cervical disc disease managed by ACDF with stand-alone intervertebral cages: safe and effective. Paper AB3. Presented at Spine Week 2008. Geneva, Switzerland.