Is it possible to eliminate the plate-related problems and still achieve satisfactory outcome after multilevel anterior cervical discectomy?

BACKGROUND: Stand-alone cage-assisted anterior cervical discectomy and fusion (ACDF) has proved to be safe and effective procedure for treatment of mono-segmental cervical degenerative stenosis (CDS). However, the success rate has reported to decline as the number of levels increases. The aim of this prospective study was to evaluate the short-term results of multilevel ACDF using stand-alone polyetheretherketone (PEEK) cages. PATIENTS AND METHODS: Twenty-eight patients (16 males and 12 females; mean age 40.5 years) of symptomatic multilevel CDS were enroled in this study and completed a 2-year post-operative follow-up. All patients underwent contiguous multilevel ACDF, using indirect decompression and stand-alone PEEK cages, between 2009 and 2012. Ten patients underwent two-level fusions (group I), ten underwent three-level fusions (group II), and eight underwent four-level fusions (group III). The visual analogue scales of neck and arm pain and Odom's criteria were used to evaluate clinical outcomes. Radiological evaluation was done to evaluate: fusion, cervical sagittal angle (CSA) and cage subsidence.
RESULTS: There was a statistical significant improvement in clinical parameters and radiological CSA values in all groups post-operatively. This improvement was well maintained till final follow-up. Subsidence and non-union were encountered in seven and two fusion levels, respectively, with no significant differences between groups. All patients were satisfied and none of them had major complications or required revision surgery.
CONCLUSION: With proper patient selection, meticulous surgical technique and strict post-operative cervical bracing, the less-invasive indirect anterior cervical decompression technique augmented with stand-alone PEEK cage-assisted ACDF is an efficient and safe method for the treatment of multilevel CDS.