Neurosurgeon Las Vegas Neurosurgical Institute Las Vegas, Nevada, United States
Introduction: Alternatively to ACDF with a cervical plate and quite possibly superior to plating, cervical integrated interbody fusions with subsequent compressive/lag fixation, has emerged as a promising alternative: smaller exposure, zero-anterior profile, individual, but multilevel-specific sagittal realignment.
Purpose: Retrospectively to evaluate patients treated from single-to-multiple levels with integrated interbody fusion.
Methods: 142 consecutive patients with symptomatic DDD with radiculopathy and/or myelopathy were treated in 2011-2016 with a cervical integrated interbody fusion device with compressive fixation. 74 patients underwent the procedure at single-level, and 68 patients at 2-level. The average age at time of surgery was 53.4±10.7 years. Patients were assessed pre- and post-operatively at 6 weeks, 3, 6, 12-months, then yearly and evaluated at 6-11 years follow-up for patient-derived outcome measures, radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment, fusion status), and device-related complications. Also blood loss and hospital stay were evaluated.
Results: Blood loss was minimal and no intra-operative complications were recorded. Hospital stay was minimal with 84% of patients being released the same day. Radiographic results showed lordosis was maintained in the global spine and bone formation was present in the inner column of the device. Overall fusion rate was 92%. The revision surgery patients showed better alignment than pre-operatively with static plates. At 6 months, none of the patients reported chronic dysphagia. There were no device failures out to last follow-up. 86% of patients were able to return to the same-level of work as prior to surgery.
Conclusion : For patients undergoing one- and two-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. The benefit of a lag design to provide better fixation and more accurate maintenance of the lordotic curve of the cervical spine was seen in this series. Patients reported they were well satisfied with their results and experienced significant pain relief.
