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

Jeremie D. Oliver, Sandy Goncalves, Panagiotis Kerezoudis, Mohammed Ali Alvi, Brett Freedman, Ahmad Nassr, Mohamad Bydon

Research output: Contribution to journalReview article

10 Citations (Scopus)

Abstract

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

Original languageEnglish (US)
Pages (from-to)E413-E422
JournalSpine
Volume43
Issue number7
DOIs
StatePublished - Apr 1 2018

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Diskectomy
Confidence Intervals
Neck Pain
Visual Analog Scale
Odds Ratio
Deglutition Disorders
Arm
Neck
Randomized Controlled Trials
Pain Measurement
Observational Studies
Meta-Analysis

Keywords

  • ACDF
  • cervical
  • discectomy
  • dysphagia
  • fusion
  • meta-analysis
  • orthopedic
  • spine
  • spine surgery
  • systematic review

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Comparison of Outcomes for Anterior Cervical Discectomy and Fusion with and Without Anterior Plate Fixation. / Oliver, Jeremie D.; Goncalves, Sandy; Kerezoudis, Panagiotis; Alvi, Mohammed Ali; Freedman, Brett; Nassr, Ahmad; Bydon, Mohamad.

In: Spine, Vol. 43, No. 7, 01.04.2018, p. E413-E422.

Research output: Contribution to journalReview article

Oliver, JD, Goncalves, S, Kerezoudis, P, Alvi, MA, Freedman, B, Nassr, A & Bydon, M 2018, 'Comparison of Outcomes for Anterior Cervical Discectomy and Fusion with and Without Anterior Plate Fixation', Spine, vol. 43, no. 7, pp. E413-E422. https://doi.org/10.1097/BRS.0000000000002441
Oliver, Jeremie D. ; Goncalves, Sandy ; Kerezoudis, Panagiotis ; Alvi, Mohammed Ali ; Freedman, Brett ; Nassr, Ahmad ; Bydon, Mohamad. / Comparison of Outcomes for Anterior Cervical Discectomy and Fusion with and Without Anterior Plate Fixation. In: Spine. 2018 ; Vol. 43, No. 7. pp. E413-E422.
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abstract = "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",
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AU - Oliver, Jeremie D.

AU - Goncalves, Sandy

AU - Kerezoudis, Panagiotis

AU - Alvi, Mohammed Ali

AU - Freedman, Brett

AU - Nassr, Ahmad

AU - Bydon, Mohamad

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N2 - 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

AB - 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

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