Two-level anterior cervical discectomy and cage-assisted fusion without plates

Abstract

Object Anterior cervical discectomy (ACD) is an effective and safe treatment for nerve root or spinal cord compression caused by disc herniation or spondylosis. Cervical interbody fusion allows preservation of the physiological lordosis and stability of the cervical spine. Based on data reported in the literature, fusion rates decrease significantly when more than one level undergoes surgery, and some authors recommend the addition of a plate system to improve results. At the authors' institution cervical carbon fiber cages (CFCs) are routinely used after ACD. They describe their experience in the treatment of 24 patients with two-level disease treated with CFCs alone. Methods Twenty-one patients with cervical radiculopathy and three with radiculomyelopathy underwent ACD. Surgery was performed at C5–6 and C6–7 in 18, at C4–5 and C5–6 in four, and at C3–4 and C5–6 in two patients. All the patients underwent magnetic resonance imaging and 15 also underwent computerized tomography (CT) to assess the results of surgery. Radiculopathy improved after surgery in all the cases, whereas myelopathy resolved in only one patient. At 1 year fusion was achieved in 96% of the surgically treated discs; this was verified on cervical spine x-ray films in all patients and on CT scans in three patients. Cervical lordosis was restored in eight of the nine patients in whom it was lost preoperatively. No complications related to cage extrusion and no cases of symptomatic pseudarthrosis were observed. Conclusions Interbody fusion cages have a load-sharing function and stabilize the spine to increase segmental stiffness, thus achieving fusion rates similar to those associated with bone grafts, even in multilevel disease.