Comparison of Outcomes for Anterior Cervical Discectomy and Fusion With and Without Anterior Plate Fixation: A Systematic Review and Meta-Analysis

• Published in: Spine (Philadelphia, Pa. 1976) Vol. 43; no. 7; pp. E413 - E422
• Main Authors: Oliver, Jeremie D., Goncalves, Sandy, Kerezoudis, Panagiotis, Alvi, Mohammed Ali, Freedman, Brett A., Nassr, Ahmad, Bydon, Mohamad
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health, Inc. All rights reserved 01-04-2018; Copyright Wolters Kluwer Health, Inc. All rights reserved
• Subjects: Aged; Bone Plates; Cervical Vertebrae - surgery; Deglutition Disorders - etiology; Diskectomy - methods; Female; Humans; Male; Middle Aged; Pain Measurement; Patient Reported Outcome Measures; Spinal Fusion - methods; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000002441

STUDY DESIGN.Systematic review and meta-analysis.
OBJECTIVE.To compare postoperative surgical, radiographic and patient-reported outcomes following ACDF with and without plate fixation.
SUMMARY OF BACKGROUND DATA.Anterior cervical discectomy and fusion (ACDF) has evolved significantly over the years, including the placement of an anterior plate construct. Although promoting bony osseo-integration at the fusion site, there are a number of plate-related complications that can arise. The non-plating approach is less invasive, however greater rates of cage subsidence have been associated with this model.
METHODS.We performed an electronic literature search for human studies that directly compared ACDF with and without anterior plate fixation. Outcomes of interest comprised of postoperative dysphagia, fusion success and cage subsidence as well as patient reported outcomes, including the Neck Disability Index (NDI) scores and Visual Analog Scale (VAS) for both neck and arm pain.
RESULTS.A total of 15 studies (12 observational and 3 randomized controlled trials) and 893 patients (57% males) were included. Overall, ACDF with plate fixation was associated with significantly higher vertebral fusion rates (odds ratio (OR) 1.98; 95% CI 1.16 to 3.37), lower subsidence rates (OR 0.31, 95% CI 0.18 to 0.52) and more favorable VAS-neck pain scores at last follow-up (mean difference (MD) 0.59, 95% CI -0.78 to -0.41). Conversely, ACDF procedures without plate fixation had marginally better long-term VAS-arm pain scores (MD 0.2, 95% CI 0.04 to 0.36). No difference was found with regards to dysphagia (OR 1.21, 95% CI, 0.57 to 2.56) and NDI (MD - 0.06, 95% C.I -0.54 to 0.42).
CONCLUSIONS.Available evidence, although limited, suggests superior surgical outcomes in ACDF procedures with anterior plate fixation (increased fusion, decreased subsidence) and slightly better VAS-neck pain scores at last follow-up. Future longitudinal, multi-center randomized controlled trials should be completed to validate any associations found in this study.Level of Evidence3