同种异体骨椎间融合器在颈椎前路手术中应用的临床效果

目的 评估同种异体骨椎间融合器（Cage）在颈椎前路椎间盘切除融合术（ACDF）中的临床疗效及安全性。方法 回顾性分析2015年6月至2018年3月使用同种异体骨Cage行ACDF手术者45例（48节段）,收集其术前、术后3个月、术后6个月及末次随访时的疼痛视觉模拟量表（VAS）、颈椎功能障碍指数（NDI）评分、日本骨科协会（JOA）脊髓型颈椎病评分、椎间隙高度。术后3、6个月摄颈椎正侧位X线片、行CT三维重建评估融合率。结果 随访时间为（16.18±6.78）个月（6~25个月）。与术前的数值比较,45例病人术后3个月、术后6个月及末次随访时的VAS评分、NDI及JOA评分均有不同程度的改善,椎间融合率分别为64.58%（31/48）、93.75%（45/48）、100%（48/48）;椎间隙高度分别为（9.25±0.50） mm、（8.85±0.46） mm、（8.25±0.48） mm,均较术前显著改善,差异均有统计学意义（P均＜0.05）。无神经压迫、受损症状,无Cage脱出、位移等情况发生。结论 同种异体骨椎间融合器用于ACDF手术可提供早期的稳定和较高的融合率,且安全性良好。     

同种异体骨笼复合自身红骨髓植骨在颈椎前路手术中的应用

目的探讨同种异体骨笼(ATFC)复合自身红骨髓混合植骨在颈椎前路椎间植骨融合中的应用价值.方法对34例颈椎前路减压植骨融合的患者应用红骨髓与ATFC混合植骨,记录手术时间、术中出血量及定期X线片等资料,并与同期单纯行ATFC植骨的19例对照组的相关资料进行比较.结果在随访中发现,加红骨髓的ATFC植骨组与单纯ATFC植骨组比较并未延长手术时间或增加手术出血量,但可缩短椎间骨融合时间(P<0.01).结论 ATFC复合红骨髓植骨,柔合了异体骨植骨中没有取骨附加创伤和自身红骨髓独有的活跃成骨能力的优点,植骨可顺利融合,是一个值得推广应用的良好术式.     

同种异体骨在脊髓型颈椎病椎体次全切除减压融合术中的应用

目的 评价同种异体骨联合前路钢板在脊髓型颈椎病椎体次全切除减压融合术中的应用效果。方法 对35例颈脊髓病患者行颈前路椎体次全切,同种异体骨植入联合前路钢板内固定并分析其结果。术前JOA评分4—15分,平均8．7分。结果 本组35例患者,次全切除椎体69个,其中单椎体次全切7例,双椎体22例,三椎体6例,完成减压104个间隙,无手术并发症。随访时间11—37个月,平均17．4个月。术后植骨稳定,未发现钢板、螺钉松动、断裂等现象,植骨融合率100％;融合时间约6—15个月,平均9．3个月;术后JOA评分7—17分,平均14．8分,改善率为73．5％,优良率为82．8％。结论 在颈脊髓病椎体次全切减压术中,使用同种异体骨结合颈前路钢板进行融合和固定可以简化手术步骤、减少创伤,且融合可靠。     

原位自体骨与同种异体骨混合移植在腰椎后外侧融合术中的应用

目的 评价原位自体骨与同种异体骨混合植骨在腰椎后外侧融合术中的临床应用及疗效.方法 2005年3月-2007年4月,于腰椎后外侧融合术中应用原位自体骨及同种异体骨植骨治疗22例腰椎疾患患者,回顾性分析术后体温、引流量、切口愈合时间;采用视觉模拟评分法(visual analog scale,VAS)和JOA评分评估患者术后腰椎疼痛情况;采用MacNab疗效评价标准和Oswestry功能障碍指数(Oswestry disability index,ODI)进行术后疗效评定;采用Jorgenson标准评价术后融合节段的融合率.结果 术后22例均获随访,随访时间17～35个月,平均21个月.术后切口均Ⅰ期愈合,未发生切口红肿、渗出、感染.JOA评分:优4例,良14例,中4例,优良率为81.8‰MacNab疗效评价:优4例,良13例,中5例,优良率为77.3%;ODI指数评价:优3例,良17例,中2例,优良率为90.9%.术后1年X线片示脊柱融合20例,2例未融合,融合率为90.9%.结论 在腰椎后外侧融合术中,原位自体骨混合同种异体骨移植可获得良好术后疗效和融合率.     

复合可诱导DBM的同种异体骨垫(Spacer)在颈椎前路融合术中的临床应用及近期随访观察

[目的]评价复合可诱导DBM的同种异体骨垫在颈椎前路融合术中的临床疗效.[方法]在12例(男6例,女6例)行颈椎前路减压椎间融合患者中,应用自行研制的复合可诱导DBM同种异体骨垫作为融合介质,融合14个节段,其中外伤性颈椎不稳10例,脊髓型颈椎病2例.根据术前术后椎间隙高度、颈椎前凸Cobb角、JOA评分、融合时间、体温变化及伤口愈合情况,分析评价临床疗效.[结果]患者术后即刻椎间隙高度、颈椎前凸角、椎间前凸角与术前比较,差异均有统计学意义(P＜0.05),而末次随访时与术后即刻比较,差异无统计学意义(P＞0.05).X线片及CT示所有病变椎间隙均达到骨性融合,平均融合时间3.8个月,动态照片未见假关节形成,无神经系统并发证,无融合骨垫以及钢板的移位,椎体无塌陷,切口无感染,JOA评分术后改善率为61％.[结论]复合可诱导DBM的同种异体颈椎融合骨垫(spacer)力学强度好,可辅助维持颈椎的生理弧度和椎间隙的高度,促进椎间隙的骨性融合,提高融合率,是一种理想的颈椎前路融合器.     

同种异体骨与自体骨在颈椎结核植骨融合中的应用比较

目的通过与自体骨比较,评价同种异体骨在颈椎结核前路椎间植骨融合中的疗效。方法 2000年1月-2008年1月,对30例下颈椎结核行前路彻底清除病灶、植骨及内固定术,根据植骨材料不同,分为同种异体冷冻干燥骨组(A组)和自体髂骨组(B组)。A组15例,男8例,女7例;平均年龄38岁。病程6～14个月。术前后凸Cobb角(8.6±11.3)°,神经功能按日本骨科协会(JOA)评分为(13.0±3.1)分;术中植骨长度平均32 mm。B组15例,男9例,女6例;平均年龄42岁。病程4～17个月。术前后凸Cobb角(4.9±7.4)°,JOA评分为(12.3±4.2)分;术中植骨长度平均34 mm。两组患者一般资料比较差异均无统计学意义(P>0.05),有可比性。结果 A组手术时间及术中出血量均少于B组,比较差异有统计学意义(P<0.05)。A组术后2例切口渗液,其余患者切口均Ⅰ期愈合;B组无感染发生,切口均Ⅰ期愈合。A组13例获随访,随访时间12～48个月;B组14例获随访,随访时间13～46个月。A组植骨融合时间为(7.6±2.1)个月,与B组(4.2±1.1)个月比较差异有统计学意义(t=2.773,P=0.005)。两组术后6个月及末次随访时后凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05);术后各时间点两组间后凸Cobb角比较差异均无统计学意义(P>0.05)。术后6个月两组JOA评分分别为(14.1±2.6)分和(14.3±2.4)分,比较差异无统计学意义(t=1.655,P=0.162)。A、B组术后有效改善率分别为83.7%和87.8%,差异无统计学意义(χ2=3.150,P=0.071)。两组内固定物均牢靠无松动,随访期间均无结核复发。B组5例出现髂骨取骨区疼痛。植骨融合采用Bridwell等的标准评价,A组满意11例(84.6%),不满意2例(15.4%);B组满意14例(100%);A、B组植骨融合满意率比较差异无统计学意义(χ2=2.680,P=0.115)。结论与自体骨相比,同种异体骨在颈椎结核前路植骨融合中疗效满意,可有效修复颈椎结核病灶清除术后的骨缺损。     

同种异体骨笼在颈椎前路融合的应用观察

目的：探讨应用同种异体骨笼行颈椎前路融合的效果。方法：对287例颈椎疾患采用颈椎前路减压、同种异体骨笼植入椎体间融合术，随访观察神经功能恢复、植骨融合情况、椎间隙高度和颈椎生理曲度变化及内置物并发症等。结果：全组手术历时平均50min，术中出血量平均110ml。228例获平均14个月随访。骨融合时间为3-5个月，平均4个月；单节段骨融合率为98．3％，双节段为94．4%，三节段为86．9％，平均93．3％。椎体间高度术后即时略有增高，术后3—5个月内有丢失，之后稳定。颈椎生理曲度恢复并维持，仅1例向后成角畸形；3例出现骨笼崩裂。无植骨排斥反应。结论：用同种异体骨笼行颈椎体间融合的融合率达90％以上；可缩短手术时间．减少并发症．能替代自体髂骨移植。     

异体复合骨环前路腰椎间融合术的实验研究

目的 比较异体复合骨环和自体髂骨块行腰椎椎间融合的实验结果。研究异体复合骨环行腰椎椎间融合的生物学特点。方法 用8只成年杂种犬,实验以犬腰椎椎间盘摘除后的椎间隙作为实验模型。分别交叉配对植入复合骨环和自体髂骨块,植入1、2、4和6个月后,每组每时间点取2只犬行X线正侧位摄片和组织学观察。结果 X线片和组织学观察见异体复合骨环愈合速度快,术后4个月弩 达到椎间融合的目的,表现出与大段同种异体骨移植不同的成骨方式,而髂骨组以常见的自体骨移植方式愈合,术后6个月,自体髂骨块与周围骨质融合。结论 复合骨环行前路腰椎椎间融合有独特的丹掺入方式,是理想的移植材料。     

同种异体骨圈在颈椎前路融合术中的应用

目的 了解同种异体骨圈 (allograft fusion cage, AFC)在颈椎前路椎体融合术中应用的效果。方法 从 1995年 9月 ,在 31例颈椎病、 6例颈椎骨折脱位、 2例急性颈椎间盘脱出症患者行颈椎前路手术中 ,将自制 AFC植入到 61个病变椎间隙。术后观察临床效果及手术并发症 ,并行 X线评价。结果 39例患者随访平均 28.6个月 ,临床效果满意,无神经并发症发生,无 AFC移位脱出。术后 3个月摄动态 X线片, 61个椎间隙平均 3.9个月完全骨性愈合。 59个椎间隙无塌陷、成角畸形, 2例 2个椎间隙因过早去除外固定,椎间高度轻度丢失。结论 与传统颈椎前路减压椎间融合术相比, AFC植入操作简便、固定稳定、手术创伤小、时间短,椎间骨融合率相近,并因无需取自体髂骨和应用金属支架,消除了取髂骨及金属内固定物永久植入所引起的一些并发症。     

椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术中的应用

目的 分析椎体原位骨屑植骨技术在颈前路椎间盘切除减压融合内固定术(Anterior cervical discectomy and fu-sion,ACDF)中的应用效果.方法 回顾性分析自2015-01-2018-12采用ACDF治疗的184例退行性颈椎病,104例采用椎体原位骨屑植骨技术进行椎间融合(原位骨屑组),...     

Bone graft substitutes in anterior cervical discectomy and fusion

Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor- and cell-based technologies.     

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom’s criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara’s index at 1 year. Group 1 had a mean age 46.2 years (range 35–60 years). Group 2 had a mean age 50.1 years (range 35–70 years).The operative time was significantly lower (P < 0.001) and blood loss significantly higher (P < 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P > 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P > 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.     

Complications of anterior cervical discectomy and fusion using recombinant human bone morphogenetic protein-2

The use of bone morphogenetic protein-2 (rhBMP-2) in spinal fusion has increased dramatically since an FDA approval for its use in anterior lumbar fusion with the LT cage. There are several reports of its use in transforaminal lumbar interbody fusion, posterolateral fusion, and anterior cervical fusion. Reports on adverse effects of rhBMP-2 when used in spinal fusion are scarce in literature. An Institutional Review Board approved retrospective study was conducted in patients undergoing anterior spinal fusion and instrumentation following diskectomy at a single center. Forty-six consecutive patients were included. Twenty-two patients treated with rhBMP-2 and PEEK cages were compared to 24 in whom allograft spacers and demineralized bone matrix was used. Patients filled out Cervical Oswestry Scores, VAS for arm pain, neck pain, and had radiographs preoperatively as well at every follow up visit. Radiographic examination following surgery revealed end plate resorption in all patients in whom rhBMP-2 was used. This was followed by a period of new bone formation commencing at 6 weeks. In contrast, allograft patients showed a progressive blurring of end plate-allograft junction. Dysphagia was a common complication and it was significantly more frequent and more severe in patients in whom rhBMP-2 was used. Post operative swelling anterior to the vertebral body on lateral cervical spine X-ray was significantly larger in the rhBMP-2 group when measured from 1 to 6 weeks after which it was similar. These effects are possibly due to an early inflammatory response to rhBMP-2 and were observed to be dose related. With the parameters we used, there was no significant difference in the clinical outcome of patients in the two groups at 2 years. The cost of implants in patients treated with rhBMP-2 and PEEK spacers was more than three times the cost of allograft spacers and demineralized bone matrix in 1, 2, and 3-level cases. Despite providing consistently good fusion rates, we have abandoned using rhBMP-2 and PEEK cages for anterior cervical fusion, due to the side effects, high cost, and the availability of a suitable alternative.     

颈椎前路钩椎关节融合与传统椎骨终板间融合的融合时效比较：一项前瞻性随机对照研究

目的 ：比较颈椎前路融合术(anterior cervical discectomy and fusion,ACDF)中,钩椎关节融合(uncovertebral joint fusion,UJF)与传统椎骨终板间融合(traditional interbody fusion,TIF)的融合时效和安全有效性。方法：2020年5月～2021年6月招募并收治44例单节段颈椎病患者,使用计算机随机数表法分为观察组和对照组,每组22例。观察组施行UJF,对照组施行TIF。两组均取自体髂骨进行植骨融合。通过动力位X线片及CT评估两组术后早期(术后3个月、6个月)融合率。通过日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数(neck disability index,NDI)、疼痛视觉模拟评分(visual analogue scale,VAS)评估两组的临床疗效。结果：共有40例患者完成了计划随访,UJF组20例,TIF组20例。两组患者年龄、性别比、体重指数(BMI)均无统计学差异(P>0.05)。两组手术时间(133.0±2...     

前路椎间盘切除减压融合与椎体次全切除减压融合治疗多节段颈椎病疗效比较

目的比较前路椎间盘减压融合(ACDF)与前路椎体次全切除减压融合(ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间:观察组(128.3±32.4)min,对照组(163.2±43.6)min;术中出血量:观察组(161.4±122.5)ml,对照组(319.2±308.7)ml;以上指标观察组均少于对照组(P0.05)。术后住院时间:观察组(8.1±3.6)d,对照组(9.5±4.2)d;术后6个月时JOA评分:观察组(12.1±2.2)分,对照组(11.7±2.1)分;颈椎总活动度:观察组26.6°±7.3°,对照组30.5°±8.1°;以上指标两组间差异无统计学意义(P0.05)。术后颈椎曲度:观察组23.5°±7.4°,对照组16.1°±7.2°;椎间节段性高度:观察组5.6°±0.4°,对照组4.7°±0.8°;以上指标两组比较差异有统计学意义(P0.05)。结论 ACDF较ACCF手术时间短、术中出血量少、颈椎生理弯曲和椎间节段高度恢复更好。     

颈椎前路手术后吞咽困难的原因分析

目的：探讨颈椎前路手术后发生吞咽困难的相关因素。方法：随访2002年10月～2004年10月间颈椎前路手术患者490例。其巾男306例，女184例；年龄12～76岁，平均47．2岁；诊断为颈椎病415例，颈椎骨折脱位43例．颈椎间盘突出症22例，颈椎椎体肿瘤8例．颈椎结核2例。观察患者手术后是否存在吞咽困难；对于存在吞咽困难的患者均静脉应用地塞米松及对症治疗。结果：共有96例（19．6％）患者出现不同程度吞咽困难，持续时间3周～24个月。男42例，女54例，年龄38～63岁，平均57．6岁。96例吞咽困难患者巾，使用钛板内同定89例．使用颈椎椎间融合器7例：颈椎融合术未加内固定者及颈椎人工间盘置换者均未出现吞咽困难病例。女性、高龄及使用钛板内植物等因素与吞咽困难之间存在相关性。96例患者平均随访14．2个月，90例（93．7％）吞咽困难的症状消失或减轻，6例（6.3％）症状无改善。结论：吞咽困难是颈椎前路手术后常见的并发症；其发生可能与多种因素有关。临床医生应给予相应重视和采取相应措施以减少其发生。     

A meta-analysis of autograft versus allograft in anterior cervical fusion

We performed a meta-analysis of one- and two-level anterior cervical interbody fusion (ACDF) on data derived from published, peer-reviewed journal articles to determine whether there is a difference in fusion rate, graft complications, or clinical outcome in patients undergoing ACDF according to whether autograft or allograft was used. ACDF is a common procedure for cervical spondylotic radiculopathy. Most published studies comparing autograft and allograft have not demonstrated any difference between grafts. The medical literature dating from 1955 was reviewed. Of 395 titles, only four studies comparing autograft with allograft in ACDF were appropriate for this analysis. The data from these studies – 310 patients and 379 intervertebral levels – were pooled and statistical methods were applied. For both one- and two-level ACDF, autograft demonstrated a higher rate of radiographic union and a lower incidence of graft collapse. It was not possible to ascertain whether autograft is clinically superior to allograft. Although autograft has a higher fusion rate than allograft, clinical results do not depend solely on radiographic results. The risk of graft site morbidity and patient preference should be considered when choosing the type of graft for this operation. Received: 29 November 1999/Revised: 29 February 2000/Accepted: 23 March 2000     

Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an established procedure for the operative treatment of cervical disc disease in patients with radiculopathy resulting from impingement from uncovertebral joint osteophytes. Studies demonstrate that direct decompression of the lesion provides good result. However, known complications include vertebral artery injury, dural tears, nerve root injury, loss of biomechanical stability and increased operative time. Other studies suggest that disc space distraction may play an important role by indirectly decompressing neural elements. Therefore, if equivalent functional outcomes can be achieved without sacrificing the uncovertebral joint, then potential morbidity and mortality could be decreased. PURPOSE: To assess and compare clinical and radiographic outcomes of patients with neck pain and cervical radiculopathy who underwent instrumented ACDF with or without direct uncovertebral joint decompression. STUDY DESIGN/SETTING: Retrospective clinical chart and radiographic review to assess clinical outcome and graft fusion in 109 patients who underwent one- or two-level ACDF with rigid anterior plate fixation. PATIENT SAMPLE: Radiographs and clinical charts for 109 patients (mean, 46 years; range, 27 to 83) who underwent ACDF with rigid anterior plate fixation were retrospectively reviewed at a single institution. Patients with radiculopathy resulting from herniated disc, spondylosis or a combination of both refractory to conservative treatment underwent surgery using a standard Smith-Robinson left-sided approach. Seventy-one patients who received direct uncovertebral joint decompression (Group 1) were compared with 38 patients without direct decompression but indirect decompression by disc space distraction (Group 2). In Group 1, 37 one-level and 34 two-level ACDFs were performed. In Group 2, 11 and 27 were one-level and two-level ACDFs, respectively. Smoking and work-related injuries involved 26.7% and 38.0% of Group 1 and 28.9% and 28.9% of Group 2, respectively. Autologous iliac crest grafts were used in 51 patients, whereas 58 patients received allograft. OUTCOME MEASURES: Independent blinded analyses of plain lateral neutral, flexion and extension radiographs were conducted to assess fusion, evaluate graft and plate and screw integrity (mean, 12 months). Clinical outcomes were reported as excellent, good, fair or poor (mean, 23 months) based on Odom's criteria. METHODS: Postoperative clinical outcome and radiographic studies of graft and instrument integrity were assessed in 71 patients undergoing ACDF with uncovertebral joint decompression and 38 patients without uncovertebral joint decompression, but with indirect decompression through disc space distraction. RESULTS: Fusion occurred in 95.8% of Group 1 and 100% of Group 2. In Group 1, 26.8% of the patients reported excellent results, 57.7% reported good results, 12.7% reported fair results and 2.8% reported poor results. In Group 2, 23.7% of the patients reported excellent results, 60.5% reported good results and 15.8% reported fair results. All nonunions reported good outcomes. Postoperative respiratory distress developed in one patient and dysphagia developed in another both from Group 1. No other complications were noted. The presence or absence of direct uncovertebral joint decompression and clinical outcome was not statistically significant (p>.05). The use of graft-type, operative level, presence of smoking and work-related injury in relation to clinical outcome was not found to be significant (p>.05). CONCLUSION: Good to excellent results were obtained in 84.5% and 84.2% of patients for Groups 1 and 2, respectively. Indirect foraminal decompression through distraction remains somewhat controversial during ACDF. However, sacrificing the uncovertebral joint can increase operative time and potentially increase complication rates. This study demonstrates that ACDF with or without direct uncovertebral joint decompression can provide good clinical results for neck pain with cervical radiculopathy. Therefore, routine direct uncovertebral joint decompression should not be undertaken during ACDF.     

Plate augmentation in anterior cervical discectomy and fusion with cage for degenerative cervical spinal disorders

Anterior cervical discectomy and fusion (ACDF) with cage alone (ACDF-C) is associated with a significant incidence of subsidence, local kyphosis, and migration. The use of concurrent plate augmentation may decrease the incidence of these complications while improving the fusion rate. The purpose of the study is to present our results with ACDF with cage and plate augmentation (ACDF-CPA) and to compare these results to previous reports of outcomes following ACDF-C. We evaluated the radiologic and clinical parameters of 83 patients (266 fusion sites) who had an ACDF-CPA between March 2002 and May 2006. Radiologic parameters included fusion rate, fusion time, fusion type, site of pseudoarthrosis and rate and degree of subsidence. Clinical parameters included complications and overall outcomes assessed with Robinson’s criteria; 79 of 83 patients showed bony fusion (95.1%) at last follow-up postoperatively, and there was no significant difference in fusion rate between the number of fusion levels. Type I (pseudoarthrosis) was noticed in 9 patients (12 fusion sites), type II in 14 (19 fusion sites), and type III in 60 (235 fusion sites). Five type I and all type II fusions converged into type III by the last follow-up; 76 of 83 patients (91.6%) experienced good clinical outcomes. Pseudoarthrosis occurred more commonly in more proximal locations, and the subsidence rate was significantly greater in two-level fusions when compared with single-level fusions (P = 0.046). There were four metal-related complications. Plate augmentation in one- or two-level anterior cervical fusions for degenerative cervical spine disorders may improve fusion rates and reduce subsidence and complication rates, resulting in improved clinical outcomes.