1520. Comparison of Clinical Outcomes after Standalone versus Cage and Plate Constructs for Anterior Cervical Discectomy and Fusion

Authors: Islam Fayed, MD; Kelsey Cobourn, BS; Marcelle Altshuler, BS; Gregory Keating, BS; Steven Spitz, MD; Amjad Anaizi, MD; M. Nair, MD, MPH; Jean-Marc Voyadzis, MD; Faheem Sandhu, MD, PhD (Washington, DC)

Introduction:

Anterior cervical discectomy and fusion (ACDF) has conventionally been performed using an allograft cage with a plate and screw construct. Recently, standalone cage systems have gained popularity due to a theorized decrease in operative time and postoperative dysphagia. Few studies in the literature have compared these outcomes.

Methods:

A single-center retrospective review of all patients undergoing one, two, or three level ACDFs by five spine surgeons after June 2011 with at least 6 months of follow-up was conducted.  Clinical outcomes were analyzed and compared between standalone and plated constructs. Multivariate regression analysis of the primary outcome, need for revision surgery, as well as the secondary outcomes, procedure duration, estimated blood loss, incidence of dysphagia or hoarseness, and length of hospital stay, was completed.

Results:

244 patients underwent ACDF and met inclusion and exclusion criteria, with a mean follow-up duration of 20 months. 32 (13.1%) patients received standalone constructs, while 212 (86.9%) received plated constructs. 18 (7.4%) total revisions were necessary, 5 (15.6%) in the standalone group and 13 (6.1%) in the plated group (p=0.046). Mean estimated blood loss was 121cc in the standalone group and 71cc in the plated group (p=0.001). Mean procedure duration was 150min in the standalone group and 154 min in the plated group (p=0.048). Mean hospital stay was 5.7 days in the standalone group and 2.7 days in the plated group (p=0.045). There was no statistically significant difference in incidence of dysphagia (p=.578) or hoarseness (p=.584).

Conclusion:

Standalone ACDF constructs require revision more frequently than conventional plate and screw constructs, without the hypothesized decreased incidence of dysphagia or hoarseness, and without decreased procedure duration or estimated blood loss. Surgeons may consider limiting use of these constructs to cases of adjacent segment disease. Larger studies with longer follow-up are necessary to make more definitive conclusions.