Journal
WORLD NEUROSURGERY
Volume 99, Issue -, Pages 630-637Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.wneu.2016.12.060
Keywords
Anterior cervical discectomy and fusion; Dysphagia; Dysphonia; Stand-alone intervertebral spacer with integrated screw fixation
Categories
Funding
- Musculoskeletal Education and Research Center (MERC)
- Division of Globus Medical, Inc.
- Baxter
- Globus Medical
- SpineGuard
- Globus Medical and Nuvasive and royalties
- Clariance
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OBJECTIVE: To compare radiologic and clinical outcomes, including rates of dysphagia and dysphonia, using a no-profile stand-alone intervertebral spacer with integrated screw fixation versus an anterior cervical plate and spacer construct for single-level anterior cervical dis-cectomy and fusion (ACDF) procedures. METHODS: This multicenter, randomized, prospective study included 54 patients with degenerative disc disease requiring ACDF at a single level at C3-C7. Twenty-six patients underwent single-level ACDF with stand-alone spacers, and 28 with plate fixation and spacers. Analyses were based on comparison of perioperative outcomes, radiologic and clinical metrics, and incidence of dysphagia and/or dysphonia. RESULTS: Mean patient age was 48.8 +/- 10.1years (53.7% female). No significant differences were observed between groups in operative time (101.8 +/- 34.4 minutes, 114.4 +/- 31.5 minutes), estimated blood loss (44.8 +/- 76.5 mL, 82.5 +/- 195.1mL), or length of hospital stay (1.2 +/- 0.6 days, 1.3 +/- 0.6 days). Mean visual analog scale pain scores and Neck Disability Index scores improved significantly from preoperative to last follow-up (10.8 +/- 2.6 months) in both groups (P < 0.05). Mean Voice Handicap Index and Eating Assessment Tool scores improved significantly from discharge to last follow-up in both groups (P < 0.05). From discharge to 6 months, the stand-alone spacers group consistently demonstrated greater improvement in Voice Handicap Index. Preoperative intervertebral disc and neuroforaminal heights increased significantly across treatment groups (P < 0.01), and no cases required surgical revision at index or adjacent levels. CONCLUSIONS: Anterior cervical discectomy and fusion with stand-alone spacers resulted in similar clinical and radiologic outcomes as compared with plate and spacers and may help minimize postoperative dysphonia.
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