Clinico- radiological evaluation of stand alone cage in degenerative cervical spine

Abstract

Age-related cervical degeneration is evident in over 50% of the middle-aged population and is the most common cause of neural dysfunction.Cervical spine anteriorly stabilised by use of anterior cervical plate, strut graft, standalone cage or combination to maintain curvature and facilitate arthrodesis. Standalone strut graft has high rate of complications such as graft subsidence, dislodgement, non-union and donor site morbidities. Anterior plating has inherent deficiencies like plate loosening, screw pull out, breakage, trachea-oesophagal irritation has increased operation time. Intervertebral cages avoid some of these difficulties due to their self-fixing construct, ability to contain graft or graft substitute in it. The aim of this study is to compare the clinical and radiological outcome of stand alone cage in single level anterior cervical discectomy and fusion used to treat cervical degenerative disc disease.We performed a prospective study of 30 patients treated with stand alone -cage in single level cervical disc disease. The clinical and radiological outcomes were evaluated which includes visual analogue scale, Japanese orthopaedic association, neck disability index, neurological status, cobbs angle, fusion and subsidence. Through Smith-Robbinson approach ACDF was done. Patients were assessed up. There is a significant improvement of symptoms reflected by VAS score for pain and functional scores like JOA and NDI. Bony fusion was achieved in 29 patients with a rate of 96.7%.Cervical spine alignment was restored in all patients with kyphosis occurring in 23.3% of patients. Cage subsidence rate was 26.7% with majority occurring in C5-6 level. Anterior cervical discectomy and inter body fusion using stand alone cervical cages can be considered a safe and equally efficient alternative to iliac crest auto graft and anterior cervical plating by providing adequate stability. Stand-alone cage can restore physiologic disc height, provide immediate load bearing support to the anterior column and facilitate arthrodesis.