Advantages of the Plating for Anterior Cervical Discectomy and fusion: Comparison with Wearing Cervical Collar Without Plate

다국어 초록 (Multilingual Abstract)

Objective: Most patients wear cervical braces regardless of any anterior cervical discectomy and fusion (ACDF) technique for cervical disc herniation, even in the plating. We compared clinical and radiological results in patients with cervical disc herniations. The purpose of this study was to evaluate the efficacy of plate insertion during ACDF and determine if this could eliminate the need for external cervical braces after ACDF.
Methods: In this study, we evaluated 67 patients treated for single level cervical disc herniation with radiculopathy. The patients were divided into two groups: 30 patients treated with ACDF using a Solis® cage with plating who did not wear a cervical brace after the operation (Group I: Plated group), and 37 patients treated with ACDF using a Solis® cage without plating who wore a cervical brace for 3 months (Group II: Non-plated group). Clinical outcomes were assessed using the neck disability index (NDI), and visual analogue scale (VAS) for neck and arm pain at different times after the surgery.
In addition, modified MacNab’s grading criteria were used to assess the subjective patients’ outcome at the last follow-up. Fusion was assessed at 6, 12, and 18 months after the surgery using upright AP, lateral, and flexion-extension views.
Results: Excellent or good results were achieved in the most patients from both groups. Patients in both groups showed marked pain relief in terms of neck and arm pain scores over all time intervals. The NDI scores in both groups significantly improved when compared to preoperative scores; however, at 1 and 2 months after the surgery, patients in Group I (Plated group) had significantly better NDI scores compared to Group II (Non-plated group). Higher rates of fusion were reported in Group I over all time intervals although none of these were statistically significant. There were two patients who required second surgery for cage subsidence in Group II.
Conclusion: Our study demonstrates that anterior cervical fusion with plating for cervical radiculopathy is a safe and effective treatment which can eliminate unnecessary need for an external cervical brace.

참고문헌 (Reference)

1 Campbell MJ, "Use of cervical collar after single-level anterior cervical fusion with plate: is it necessary" 34 : 43-48, 2009

2 Drew B, "Surgical preference in anterior cervical discectomy: a national survey of Canadian spine surgeons" 15 : 454-457, 2002

3 Yue WM, "Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5-to 11-year radiologic and clinical follow-up study" 30 : 2138-2144, 2005

4 Goffin J, "Long-term follow-up after interbody fusion of the cervical spine" 17 : 79-85, 2004

5 Jin Hoon Park, "Comparative Analysis of Cervical Arthroplasty Using Mobi-C and Anterior Cervical Discectomy and Husion Using the Solis -Cage" 대한신경외과학회 44 (44): 217-221, 2008

6 Zaveri GR, "Cervical spondylosis: the role of anterior instrumentation after decompression and fusion" 14 : 10-16, 2001

7 Shapiro S, "Cadaveric fibula, locking plate, and allogeneic bone matrix for anterior cervical fusions after cervical discectomy for radiculopathy or myelopathy" 95 : 543-550, 2001

8 Grubb MR, "Biomechanical evaluation of anterior cervical spine stabilization" 23 : 886-892, 1998

9 Shapiro S, "Banked fibula and anterior cervical locking plate" 85 : 736-737, 1996

10 Kaiser MG, "Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft" 50 : 229-238, 2002

11 Bishop R, "Anterior cervical interbody fusion using autogenic and allogeneic bone graft substrate: a prospective comparative analysis" 85 : 206-210, 1996