gms | German Medical Science

Objective: We aimed to identify technique-related factors influencing radiographic and patient-rated outcomes after two-level anterior cervical discectomy with fusion (ACDF) using either cage or autologous bone, with or without anterior plate fixation (APF).

Method: This single center study was nested within the Eurospine Spine Tango data acquisition system. Inclusion criteria: consecutive two-level ACDF patients (2004-2012) presenting with signs of degenerative cervical radiculopathy or myelopathy. Before and 12 month postoperatively, patients completed the multidimensional Core Outcome Measures Index (COMI), rated the Global Treatment Outcome (GTO) and satisfaction with care. Cervical lordosis and segmental height were assessed radiographically before, immediately postoperatively, and at last follow-up (18.2±13.3 months).

Results: 144 consecutive patients (112 with APF) were included. The use of APF versus stand-alone methods was associated with significantly increased segmental height (2.6±2.6mm vs. 1.5±2.3mm, p=0.03) and preservation of lordosis (2.8° vs. -1.7°, p<0.0001) at LFU, with comparable clinical outcome (COMI score reduction >3.3-point). Multiple regression controlling for potential confounders revealed that APF (p=0.0008) and cage (p=0.004) were associated with greater segmental height at LFU; APF was associated with a greater lordosis angle at LFU (p<0.0001). Greater increase in segmental height at LFU (p=0.02) was associated with a better GTO.

Conclusions: Adding APF was associated with greater segmental height and preservation of lordosis in two-level ACDF, especially using bone autograft, but also for cage. Clinical outcome was comparable for all groups. Though the surgical technique per se did not determine clinical outcome, patients achieving a greater segmental height difference showed a significantly better GTO.