gms | German Medical Science

Objective: Cervical multilevel anterior discectomy is frequently performed for decompression of multisegmental spinal stenosis. Stabilisation and fusion is usually attempted by interbody implants and anterior plate fixation. Common complications attributed to plate fixation are adjacent segment pathologies and dysphagia. In this investigator initiated study, we examined a low-profile interbody implant to treat multisegmental cervical spinal stenosis with regard to clinical and radiological parameters to evaluate its potential suitability as an alternative to standard plate fixation.

Methods: In this prospective observational study, 30 consecutive patients (mean age 55 years, range 34-77) with multisegmental spinal stenosis, associated with myelopathy, were treated with anterior decompression and screw-fixated low-profile interbody implants. Clinical and radiological parameters were assessed pre- and postoperatively and at 12 and 24-month follow-up.

Results: At 2 years a follow-up rate of 87 % was achieved. 2-, 3- and 4-level treatments were performed in 18, 11 and 1 cases, respectively. Within 2-year follow-up, 2 re-operations were necessary. Initial postoperative dysphagia was noted in 8 patients, in 3 patients after 1 year and in 1 patient after 2 years. Initial postoperative symptomatic recurrent laryngeal nerve paresis occurred in 4 patients, in 1 after 1 year, which resolved after 2 years. mJOA, VAS arm and VAS neck improved significantly after 2 years by 2,05 , 3,5 and 1,3 respectively. Mean initial mJOA was 13,73 (SD 1,85), after 1 year 15,97 (SD 2,32) and 15,78 (SD 2,69) after 2 years. Mean VAS Arm was initially 5,43 (SD 2,89), after 1 year 2,0 (SD 2,72) and after 2 years 1,87 (SD 2,49). VAS Neck was initially 4,2 (SD 2,57) , after 1 year 2,9 (SD 2,0) and after 2 years 2,87 (SD 2,28). No screw loosening or cage dislocations were noted within 24 months. In 2 patients progressive adjacent level ossifications were seen after 2 years.

Conclusion: In sum our study showed similar clinical improvement as previous reports using the standard technique. The incidences of dysphagia and recurrent laryngeal nerve paresis do not suggest an advantage. However, the low rate of adjacent level ossifications, which is reported in other studies with up to 45%, indicates a potential advantage over standard plate fixation. In conjunction with the positive implant safety results, low-profile implant technology appears to be a potential alternative to standard plate fixation, worth further long-time analysis.