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Stand-alone Cervical Cages Versus Anterior Cervical Plate in 2-Level Cervical Anterior Interbody Fusion Patients: Clinical Outcomes and Radiologic Changes

Oh, Jae Keun MD*; Kim, Tae Yup MD†,‡; Lee, Hyo Sang MD†,‡; You, Nam Kyu MD†,‡; Choi, Gwi Hyun MD†,‡; Yi, Seong MD, PhD†,‡; Ha, Yoon MD, PhD†,‡; Kim, Keung Nyun MD, PhD†,‡; Yoon, Do Heum MD, PhD†,‡; Shin, Hyun Chul MD, PhD§

Journal of Spinal Disorders and Techniques: December 2013 - Volume 26 - Issue 8 - p 415–420
doi: 10.1097/BSD.0b013e31824c7d22

Study Design: Retrospective study.

Objectives: To compare the efficacy of 2-level anterior cervical discectomy and fusion with cage alone (ACDF-CA) and with cage and plate construct (ACDF-CPC) with regard to clinical outcome and radiologic changes.

Summary of Background Data: The use of stand-alone cervical interbody cages in ACDF has become popular, but high subsidence rates have been reported in the literature.

Methods: A total of 54 consecutive patients who underwent 2-level ACDF-CA or ACDF-CPC after suffering from cervical radiculopathy were divided into 2 groups: group A (n=28) underwent ACDF-CA, group B (n=26) underwent ACDF-CPC. Fusion rate, global and segmental kyphosis, disk height, and subsidence rate were assessed by radiolographs. Clinical outcomes were assessed using Robinson’s criteria.

Results: Solid fusion was achieved in 96.43% (27/28) in group A and in 96.15% (25/26) in group B. Fusion segmental kyphosis of >5 degrees occurred in 14.29% (4/28) of group A and in 7.69% (2/26) of group B; however, there was no statistical difference between the 2 groups (P>0.05). Subsidence occurred in 35.71% (10/28) of group A as compared with 11.54% (3/26) of group B (P<0.05). Clinical outcomes were similar in the 2 treatment groups.

Conclusions: The use of cage and plate construct in 2-level ACDF results in a shorter fusion duration and a lower subsidence rate than that of cage alone; however, there is no significant difference in the postoperative global and segmental alignment and clinical outcomes between groups.

*Department of Neurosurgery, Spine Center, Hallym University Sacred Heart Hospital

Department of Neurosurgery, College of Medicine, Yonsei University

Spine and Spinal Cord Research Institute, College of Medicine, Yonsei University

§Department of Neurosurgery, Kangbuk Samsung Hospital, College of Medicine, Sungkyunkwan University, Seoul, Korea

The authors declare no conflict of interest.

Reprints: Keung Nyun Kim, MD, PhD, Department of Neurosurgery, College of Medicine, Yonsei University, 250 Seonanno, Seodaemun-gu, Seoul 120-752, Korea (e-mail:

Received May 30, 2011

Accepted January 23, 2012

© 2013 by Lippincott Williams & Wilkins, Inc.