Anterior cervical plate fixation had positive effect on cervical discectomy outcomes

Plate fixation with a cage after 2-level ACDF was associated with greater segmental height at final follow-up.

A single center study of the outcomes of anterior cervical plate fixation after two-level anterior cervical discectomy and fusion found the technique was associated with greater segmental height postoperatively and better preserved a patient’s spinal lordosis.

The benefits of anterior plate fixation in two-level anterior cervical discectomy and fusion (ACDF) were even greater when bone autograft or a cage was used, Jan-Karl Burkhardt, MD, and colleagues wrote in their study abstract.

Plate fixation for ACDF

“Adding anterior plate fixation [APF] was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage,” Burkhardt and colleagues wrote.

ACDF is the most commonly used anterior approach, and particularly for two-level ACDFs, there are no large studies available at the moment.

“There is no evidence of any superiority of one technique over another, especially in patient-rated outcomes,” he said.

The study Burkhardt and colleagues from the Spine Center at the Schulthess Clinic in Zurich conducted looked at 144 consecutive patients included in the EuroSpine Spine Tango data acquisition system who had signs of degenerative cervical radiculopathy or myelopathy; 113 patients were treated with APF after 2-level ACDF between 2004 and 2012 presenting with signs of degenerative cervical radiculopathy or myelopathy. Patients completed the multidimensional Core Outcome Measures Index (COMI) preoperatively and at 12 months postoperatively and they rated their global treatment outcome (GTO) and their satisfaction with care at 12 months postoperatively.

APF vs. standalone treatment

Investigators took radiographic measurements of the patients’ cervical lordosis and segmental height preoperatively, immediately postoperatively and at their last follow-up examination, according to Burkhardt.

The study analyzed the results of two-level ACDF in two groups of patients. In one group APF was used (113 patients) and in the other group (31 patients) a standalone method was used.

The most common segmental level of surgery was C4 to C7, he said.

After analyzing the results of the two methods, the researchers found the use of APF was associated with significantly increased segmental height (2.6 mm ± 2.6 mm vs. 1.5 mm ± 2.4 mm, P = 0.04) and preservation of lordosis (by 2.7° ± 4.4° vs. -1.7 ± 5°, P < 0.0001) at the last follow-up, Burkhardt and colleagues wrote.

They also found that APF with a cage was associated with greater segmental height at the final follow-up and APF was associated with a greater lordosis angle, as well.

Better results with plate or cage

The patients rated their outcomes as good in about 99% of cases, Burkhardt said. The global outcomes for both groups were improved as well.

“The COMI score improved 3 points. There were no differences in patients with plate fixation and no plate fixation in the patient-rated outcomes,” he said.

“We looked at these data closer and found the use of plate and cage were significant predictors for greater lordosis angle and segmental height at last follow up,” Burkhardt said at the meeting.

Greater increase in segmental height was associated with a better GTO.

“Adding an anterior plate was associated with a greater preservation of segmental height and lordosis in two level ACDF, especially when using bone autograft, but also for patients with cages. There was similarly good patient rated outcome 1 year after surgery. There was no superiority of one technique over the other in terms of patient rated outcome, although we saw that patients achieving greater segmental height difference showed a significantly better global treatment outcome,” Burkhardt said. – by Robert Linnehan

Reference:

Burkhardt JK, et al. Paper #13. Presented at: EuroSpine Annual Meeting; Oct. 1-3, 2014; Lyon, France.

For more information:

Jan-Karl Burkhardt, MD, can be reached at the Department of Neurosurgery, University Hospital, University of Zurich, Frauenklinikstr. 10, Nord 1 8091 Zurich, Switzerland; email: jankarl.burkhardt@gmail.com.

Disclosures: The authors report no relevant financial disclosures.