Clinical outcomes of locking stand-alone cage versus anterior plate construct in two-level anterior cervical discectomy and fusion: a systematic review and meta-analysis.

Abstract

BACKGROUND:

Two-level cervical degenerative disc disease (cDDD) can be effectively treated by anterior cervical discectomy and fusion (ACDF) similarly to single-level cDDD. Traditionally an anterior plate construct (APC) approach has been utilized, but ACDF without plate with a locking stand-alone cage (LSC) approach has emerged as an alternative option. The aim of this study was to compare the clinical outcome of LSC and APC in contiguous two-level ACDF used to treat cDDD the current literature.

METHODS:

Searches of seven electronic databases from inception to March 2018 were conducted following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Extracted data were analysed using meta-analysis of proportions.

RESULTS:

The nine observational studies that satisfied all criteria described a pooled cohort of 687 contiguous two-level cDDD cases managed by ACDF, with 302 (44%) and 385 (56%) managed by LSC and APC approaches, respectively. When compared with APC, LSC was associated with significantly increased subsidence likelihood (OR 2.75; p < 0.001), greater disc height (MD 0.60 mm; p = 0.04) and reduced cervical lordosis (MD - 2.52°; p = 0.04) at last follow-up. Operative outcomes, fusion rates, functional scores and postoperative dysphagia rates were comparable.

CONCLUSION:

Although significant radiological differences were most evident, the comparability between LSC and APC in contiguous two-level ACDF with respect to all other clinical outcomes does not implicate one approach as clearly superior to the other in two-level ACDF. Larger, randomized studies with longer follow-up are required to delineate outcomes further to validate the findings of this study. These slides can be retrieved under Electronic Supplementary Material.

• Authors: Victor M Lu, Ralph J Mobbs, Bernard Fang, Kevin Phan
• Journal: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Eur Spine J) Vol. 28 Issue 1 Pg. 199-208 (01 2019) ISSN: 1432-0932 [Electronic] Germany
• PMID: 30390163 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)

Topics

• Bone Plates
• Cervical Vertebrae (surgery)
• Diskectomy (adverse effects, methods, statistics & numerical data)
• Humans
• Intervertebral Disc Degeneration (surgery)
• Postoperative Complications
• Spinal Fusion (adverse effects, methods, statistics & numerical data)
• Treatment Outcome