The Clinical Application Of Anterior Cervical Discectomy And Fusion With Cage Alone In Multi-level Cervical Degenerative Disease

Objective: To assesse the efficacy of anterior cervical discectomy andfusion with cage alone in treating multi-level cervical degenerative disease.Methods: From January2012to January2013，62eligible patients withmulti-level cervical degenerative disease were treated，and the.clinical datawere reviewed. Of62patients,32underwent anterior cervical discectomy andfusion with cage alone (Group A), and30underwent anterior cervical disce-ctomy and fusion with plate fixation (Group B). Both groups showed nosignificant difference in gender,age,course of disease,lesion types,affectedsegments (P>0.05),it had comparability. Clinical outcomes were assessedusing Japanese Orthopedic Association (JOA) score and visual analogscales(VASs) score,the fused segment height，subsidence rates of Cages,global cervical lordosis and fusion rates were also compared.Results: The operation time of Group B(109.7±11.2min)was signify-cantly more than Group A(87.8±6.9min)(t=-2.259, P=0.037).Primary healingof incisions was obtained in all patients of two groups.All patients werefollowed,the follow-up period ranged from8to27months (average,15.8months) in Group A,and from9to28months (average,16.4months) in GroupB.There was no complication and internal fixation failure.The JOA score andVAS score were significantly improved at last follow-up when compared withpreoperative scores in two groups (P<0.05).According to Robinson standardfor axial symptom severity,the results were excellente in20cases,good in9,fair in2and poor in1,with an excellence and good rate of90.63%in GroupA; the results were excellente in19cases,good in7,fair in3and poor in1,withan excellence and good rate of86.67%in Group B;and no significantdifference was found between two groups (2=0.765, P=0.382). The fused segment height at immediate after operation and last follow-up and globalcervical lordosis at last follow-up were significantly improved when comparedwith pre-operative ones in two groups (P<0.05).There were no significantdifferences (P>0.05) between groups A and B in the Cage subsidence height[(1.4±0.9)mm vs(1.2±1.6) mm],Cage subsidence rate [9.52%(8/84)vs7.59%（6/79）]and fusion rate [95.23%(80/84)vs96.20%(76/79)].Conclusion: Anterior cervical discectomy and fusion with cage alone canobtain good clinical results and radiologicindexes, avoid plate-related compli-cations and reduce operate time.It is a safe and effective suigical option in thetreatment of multi-level cervical degenerative disease.