Multi-level Cervical Constructs in Clinical Practice using Integrated Interbody Fusion
Presented at SMISS Annual Forum 2018
By Jason Garber MD, FACS
Disclosures: Jason Garber MD, FACS None
Although extremely effective at a single level, anterior cervical discectomy and fusion (ACDF) with an anterior cervical plate (ACP) for a multilevel construct can be associated with a number of peri- and postoperative complications. Such complications include dysphagia, loss of sagittal balance secondary to plate installation, and technical difficulties with the ACP placement over multiple fusion levels. Alternatively, and quite possibly superior to cervical plating, individual 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.
Retrospectively to evaluate patients treated from single-to-multiple levels with integrated interbody fusion.
203 patients (53.4±10.7years) with symptomatic cervical degenerative disc disease with radiculopathy and/or myelopathy were treated with a cervical integrated interbody fusion device with compressive fixation (C3-C7). Patients were assessed pre- and post-operatively at 6 weeks, 3, 6 months, 1 and 2 years. Patients were evaluated for patient-derived outcome measures, and radiographic parameters (effect on device-level lordosis, overall cervical sagittal alignment, and fusion status), and device-related complications.
74 patients underwent the procedure at single level, 68 at 2-levels, 39 at 3-levels, 17 at 4-levels, 4 at 5-levels, and 1 at 6-levels. Blood loss was minimal and no intra-operative complications were recorded. 92% of patients being released from the hospital the following 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. There were no signs of heterotopic ossification of the ligaments/vertebral bodies. At 6 months, none of the patients reported dysphagia. There were no device failures. 86% of patients were able to return to the same level of work as prior to surgery.
For patients undergoing single and multi-level cervical fusion, integrated interbody fusion with compressive/lag fixation appears to be a viable alternative. Previously, studies with static integrated interbody fixation devices have not reported as well as ACP with regards to fusion and clinical outcomes. The benefit of lag-design to provide better fixation and more accurate lordotic curve maintenance of the cervical spine was seen in our series. Patients were satisfied with results and experienced significant pain relief. The opportunity to either revise a previous ACDF with ACP or add to a pre-existing ACDF offers greater flexibility to treat the index level pathology rather than global construct approach.