Double level stand alone cage assisted fusion in cervical radiculopathy [preliminary report]

ABSTRACT

Interbody fusion following ACD [Anterior cervical discectomy] for treatment of cervical radiculopathy or cervical myelopathy is thought to have several advantages compared with discectomy alone. There is no consensus, however, regarding the optimum indications for cervical fusion. Double level interbody cervical fusion adds more concern regarding fusion rates, maintenance of lordosis and sagittal balance, and clinical outcome. The aim of this study was to assess clinically and radiologically the use of standalone double cervical cage in treatment of double level cervical radiculopathy. A prospective study enrolled 10 patients [6 males and 4 females] who were surgically treated for radiculopathy secondary to double level degenerative cervical disc disease. Radiographic and clinical outcome measures were analyzed prospectively. All patients underwent a standardized clinical, neurological and radiographic examination and completed outcome questionnaires [visual analogue scale for neck and arm pain, and modified Oswestery neck disability index] preoperatively and at each postoperative intervals [6 weeks, 3, 6, 12, and 24 months], with a mean follow up 18 months. X-ray films were reviewed and assessed at the treated levels, preoperatively, 6 weeks, 3, 6, 12, and 24 months postoperatively. After standard anterior discectomy and neural decompression, PEEK stand alone cages were inserted after packing with bone graft taken from iliac crest by special device. Decompression levels were C4/5 and C5/6 in 7 patients and C5/6 and C6/7 in 3 patients. Standard statistical methods were used to compare all outcome measures. Clinical results regarding neck and arm pain was markedly improved [VAS neck 3.4 to 0.8, VAS arm 8.1 to 0.4, both are statistically significant; p < 0.05. functional outcome was improved [NDI 20.4 to 2.8, statistically significant; p < 0.05]. Lordosis was maintained in 2 cases only, and fusion was achieved in all cases without symptomatic pseudarthrosis. The standalone double interbody cages assisted fusion achieves fusion rates similar to single level fusion, but it cannot maintain or correct cervical lordosis without plate supplementation