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doi: 10.1227/NEU.0b013e31827b94d4
Research-Human-Clinical Trials

Autologous Iliac Bone Graft With Anterior Plating Is Advantageous Over the Stand-Alone Cage for Segmental Lordosis in Single-Level Cervical Disc Disease

Kim, Chi Heon MD, PhD*,‡,§; Chung, Chun Kee MD, PhD*,‡,§; Hahn, Seokyung MPH, PhD‖,¶

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BACKGROUND: Anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft and plating has been a standard surgical method for single-level cervical disc disease. The stand-alone cage was introduced to reduce graft-related morbidity. However, problems due to focal kyphosis at the operated level have been on the rise. It has been difficult to derive a conclusive answer from previous studies for the indications of each method.

OBJECTIVE: An interim analysis of a prospective randomized study was performed to compare the sagittal alignment between a stand-alone cage (ACDF cage) and autologous iliac bone graft and plating (ACDF plate).

METHODS: Twenty-nine patients were allocated to the ACDF-cage group (M:F = 17:12) and 23 to the ACDF-plate group (M:F = 14:9). Cobb angles at the operated segment (segmental angle, SA; lordosis vs kyphosis) were compared at postoperative 12 months and the other confounding factors were explored.

RESULTS: Demographic features were not different between groups. The fusion method significantly affected segmental alignment at 12 months (P = .03; odds ratio, 5.52). Preoperatively, the SA was not different between the groups (P = .18) and was similar (P = .22) immediately following the operation. However, the SA was significantly more lordotic (P < .05) in the ACDF-plate group at postoperative 12 months in comparison with the ACDF-cage group. There was no other significant risk factor for segmental kyphosis.

CONCLUSION: The stand-alone cage and autologous bone graft with plating had similar clinical outcomes, but stand-alone cage fusion may be disadvantageous from a radiological viewpoint.

ABBREVIATIONS: ACDF, anterior cervical discectomy and fusion

CA, cervical angle

NDI, neck disability index

SA, segmental angle

VAS, visual analog scale

Copyright © by the Congress of Neurological Surgeons


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