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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‖,¶

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

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

Author Information

*Department of Neurosurgery, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, South Korea

Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea

§Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea

Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea

Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea

Correspondence: Chun Kee Chung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul, 110-744, South Korea. E-mail: chungc@snu.ac.kr

Received March 19, 2012

Accepted October 18, 2012

Copyright © by the Congress of Neurological Surgeons