gms | German Medical Science

Objective: The optimal technique in the treatment of degenerative cervical spine disease (DCSD) is not yet been determined. For decades anterior cervical discectomy and fusion (ACDF) using autologous bone was the standard of care for degenerative cervical spine diseases (DCSD). However pseudarthrosis, graft-fracture, -dislocation or -resorption are highly undesired complications after ACDF. Plate stabilization (PS) was developed to reduce or avoide these complications. ACDF with PS appears to maintain the internal stabilization and yields a better fusion rate. Studies with a follow up of more than 20 years and a large number of patients are rare. The purpose of this retrospective study was to evaluate if there are any differences in the long-term clinical out come and second surgery rates after ACDF and ACDF with PS.

Method: A retrospective outcome study with a follow-up from 17–45 years (mean 25) enrolled 160 patients (87 female and 73 male). Ninety-five underwent 1 level ACDF, 58 a 2 level ACDF and 7 a 3 level ACDF with or without plate stabilization PS. The pre- and postoperative clinical status and the operation report were documented for all patients. A standardized questionnaire which included the current neurological status, NDI, PSI, Odom's and questions regarding limitations in quality of life due to the operation, was answered by each patient. A neurological examination was offered to each patient.

Results: All patients showed a significant postoperative reduction in radicular arm-and neck pain. The average postoperative NPRS was 2 and average score of the NDI was 7. After ACDF 98% of patients were satisfied according to PSI respectively 100% with PS. 90% report good to excellent functional recovery respectively 92% in the PS-group according to Odom's criteria. Second surgery rate due adjacent segment disease was 13.7% in the ACDF-group and 2% in the PS-group. None of the patients with 3-level ACDF and PS had second surgery due to degenerative changes. In both groups 100% of patients would undergo the procedure again.

Conclusions: ACDF with or without plate stabilization is a safe and effective technique in the treatment of DCSD. The long-term follow-up data of this study reveals excellent clinical results in both groups, even after more than 25 years. The reoperation rate due to degenerative changes was significantly lower in the PS-group (P=0.001).