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Comparison of Outcomes for Anterior Cervical Discectomy and Fusion With and Without Anterior Plate Fixation

A Systematic Review and Meta-Analysis

Oliver, Jeremie D., BS∗,†,‡; Goncalves, Sandy, MS∗,†; Kerezoudis, Panagiotis, MD∗,†; Alvi, Mohammed Ali, MD∗,†; Freedman, Brett A., MD§; Nassr, Ahmad, MD§; Bydon, Mohamad, MD∗,†,§

doi: 10.1097/BRS.0000000000002441

Study Design. Systematic review and meta-analysis.

Objective. To compare postoperative surgical, radiographic, and patient-reported outcomes following anterior cervical discectomy and fusion (ACDF) with and without plate fixation.

Summary of Background Data. ACDF has evolved significantly over the years, including the placement of an anterior plate construct. Although promoting bony osseo-integration at the fusion site, there are a number of plate-related complications that can arise. The non-plating approach is less invasive, however, greater rates of cage subsidence have been associated with this model.

Methods. We performed an electronic literature search for human studies that directly compared ACDF with and without anterior plate fixation. Outcomes of interest comprised of postoperative dysphagia, fusion success, and cage subsidence as well as patient reported outcomes, including the Neck Disability Index (NDI) scores and Visual Analog Scale (VAS) for both neck and arm pain.

Results. A total of 15 studies (12 observational and 3 randomized controlled trials) and 893 patients (57% males) were included. Overall, ACDF with plate fixation was associated with significantly higher vertebral fusion rates (odds ratio [OR] 1.98; 95% confidence interval [CI] 1.16–3.37), lower subsidence rates (odds ratio [OR] 0.31, 95% CI 0.18–0.52), and more favorable VAS-neck pain scores at last follow-up (mean difference [MD] 0.59, 95% CI −0.78 to −0.41). Conversely, ACDF procedures without plate fixation had marginally better long-term VAS-arm pain scores (mean difference [MD] 0.2, 95% CI 0.04–0.36). No difference was found with regards to dysphagia (OR 1.21, 95% CI, 0.57–2.56) and NDI (MD 0.06, 95% C.I −0.54 to 0.42).

Conclusion. Available evidence, although limited, suggests superior surgical outcomes in ACDF procedures with anterior plate fixation (increased fusion, decreased subsidence) and slightly better VAS-neck pain scores at last follow-up. Future longitudinal, multicenter randomized controlled trials should be completed to validate any associations found in this study.

Level of Evidence: 3

Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN

Department of Neurologic Surgery, Mayo Clinic, Rochester, MN

Mayo Clinic School of Medicine, Rochester, MN

§Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Mohamad Bydon, MD, Department of Neurologic Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905; E-mail:

Received 25 April, 2017

Revised 15 July, 2017

Accepted 19 July, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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