Standalone versus Anterior Cervical Plating for One-To-Two Level Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Comparative Study

Ammad A Baig; Alexander O Aguirre; Mohamed A R Soliman; Cathleen C Kuo; Jaims Lim; Asham Khan; Ivette Chen; Kenneth V Snyder; Elad I Levy; Adnan H Siddiqui; John Pollina; Jeffrey P Mullin

doi:10.1016/j.wneu.2023.06.121

Standalone versus Anterior Cervical Plating for One-To-Two Level Anterior Cervical Discectomy and Fusion: A Propensity Score-Matched Comparative Study

World Neurosurg. 2023 Jul 4:S1878-8750(23)00904-X. doi: 10.1016/j.wneu.2023.06.121. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA.
² Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁶ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA.
⁷ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Buffalo General Medical Center at Kaleida Health, Buffalo, New York, USA. Electronic address: jmullin@ubns.com.

PMID: 37414214
DOI: 10.1016/j.wneu.2023.06.121

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) can be performed with and without supportive anterior cervical plating. Fusion rates, incidence of dysphagia, and repeat surgery are concerns when performing ACDF with or without plating. We aimed to compare procedural success and outcomes between patients treated with and without cervical plating for 1-2 level ACDF.

Methods: A prospectively maintained database was retrospectively searched for patients who underwent 1-2 level ACDF surgery. Patients were divided into cohorts treated with plating and without (standalone). Propensity score matching (PSM) was performed to eliminate selection bias and control for baseline comorbidities and disease severity. Patient demographics (including age, body mass index, smoking status, diabetes mellitus, osteoporosis), disease presentation (cervical stenosis, degenerative disc disease), and operative details (number of operative levels, cage type used, intraoperative, and postoperative complications) were recorded. Outcomes assessed were fusion observed at 3, 6, and 12 months, patient-reported postoperative pain, and any repeat surgeries. Univariate analysis was performed according to data normality and variables for PSM cohorts.

Results: A total of 365 patients were identified (plating=289, standalone=76). After PSM, 130 patients (65 in each group) were included for final analysis. Similar mean operative times (101.3 ± 26.5-standalone; 104.8 ± 32.2-plating; P = 0.5) and mean hospital stays (1.2 ± 1.8-standalone; 0.7 ± 0.7-plating; P = 0.1) were noted. Twelve-month fusion rates were also similar (84.6%-standalone; 89.2%-plating; P = 0.6). Repeat surgery rates were equivalent (13.8%-standalone; 12.3%-plating; P = 0.8).

Conclusions: In this propensity score-matched case-control study, we report comparable effectiveness and outcomes of performing 1-2 level ACDF with and without cervical plating.

Keywords: ACDF; Anterior cervical discectomy and fusion; Cervical degenerative disease; Cervical plating; Standalone.