Subject Area

Degenerative, Cervical spine

Document Type

Original Study


Background Data: Anterior cervical discectomy and fusion (ACF) is currently the gold standard for surgical treatment of cervical degenerated disease (CDD). For many years, patients were treated with ACF using tricortical autogenous bone graft augmented with anterior cervical locking plate. Later, Cages packed with calcium triphosphate bonesubstitute were the treatment of choice. Study Design: A comparative clinical case study. Purpose: Compare the outcomes of ACF using stand-alone PEEK cages packed with calcium triphosphate bone substitute compared with tricortical iliac autograft augmented with anterior locking plate in treatment of three or more-level CDD in 47 patients.Patients and Methods: We evaluated 47 patients (22 patients in the locking plate group and 25 patients in the cage group) at our institution from January 2007 to September 2010. They were followed up for minimum 2 years. The clinical outcomes (Nurick grade and JOA score), radiographic changes (local kyphotic angle (LKA), fusion, subsidence,and adjacent disc degeneration), and complications were compared between the 2 groups. Results: The blood loss was significantly less in cage group (388 cc) than plate group (529.6cc).Both groups showed significant improvement in LKA postoperatively and at latest follow up with no significant difference. Fusion was 94.1% and 94.4% in cage andplate groups in order. There was insignificant more subsidence in cage (21.4%) than plate group (11.3 %). There was significant improvement in Nurick grading of both cage and plate groups as it improved from 3.32 and 3.68 preoperatively to 0.84 and 1.05 at latest follow up in order with no significant difference between the two groups. Final outcome was comparable in both groups: In cage group: excellent in 7 patients, good in 16, and fair in 2. In plate group, excellent in 8 patients, good in 11, and fair in 3. Conclusion: In multiple levels (three or more) ACF, the use of stand-alone PEEK cagesresults in less blood loss, less adjacent disc degeneration, less complications than the use of autograft augmented with locking plate but unfortunately, more incidence of subsidence. However, there is no significant difference in the postoperative and latest follow up LKA, fusion rate, clinical, and functional outcomes between the cage and plategroups. (2013ESJ049)


multiple level CDD, cervical locking plate, cervical PEEK cage