Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. An HS, Simpson JM, Glover JM et al (1995) Comparison between allograft plus demineralized bone matrix versus autograft in anterior cervical fusion. A prospective multicenter study. Spine 20:2211–2216

    CAS  Google Scholar 

  2. Bishop RC, Moore KA, Hadley MN (1996) Anterior cervical interbody fusion using autoeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:206–210

    Article  CAS  PubMed  Google Scholar 

  3. Bolesta MJ, Rechtine GRII, Chrin AM (2000) Three- and four-level anterior cervical discectomy and fusion with plate fixation: a prospective study. Spine 25:2040–2046. doi:10.1097/00007632-200008150-00007

    Article  CAS  PubMed  Google Scholar 

  4. Borm W, Seitz K (2004) Use of cervical stand-alone cages. Eur Spine J 13:474–477

    PubMed  Google Scholar 

  5. Brazenor GA (2007) Comparison of multisegment anterior cervical fixation using bone strut graft versus a titanium rod and buttress prosthesis: analysis of outcome with long-term follow-up and interview by independent physician. Spine 32:63–71. doi:10.1097/01.brs.0000250304.24001.24

    Article  PubMed  Google Scholar 

  6. Brown MD, Malinin TI, Davis PB (1976) A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop Relat Res 119:231–236

    PubMed  Google Scholar 

  7. Cauthen JC, Kinard RE, Vogler JB et al (1998) Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine 23:188–192. doi:10.1097/00007632-199801150-00008

    Article  CAS  PubMed  Google Scholar 

  8. Cauthen JC, Theis RP, Allen AT (2003) Anterior cervical fusion: a comparison of cage, dowel and dowel-plate constructs. Spine J 3:106–117. doi:10.1016/S1529-9430(02)00533-8

    Article  PubMed  Google Scholar 

  9. Chacko AG, Daniel RT (2007) Multilevel cervical oblique corpectomy in the treatment of ossified posterior longitudinal ligament in the presence of ossified anterior longitudinal ligament. Spine 32:E575–E580

    Article  PubMed  Google Scholar 

  10. Chen JF, Wu CT, Lee SC et al (2005) Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease. J Neurosurg Spine 3:24–28

    Article  PubMed  Google Scholar 

  11. Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617

    Article  CAS  PubMed  Google Scholar 

  12. Daubs MD (2005) Early failures following cervical corpectomy reconstruction with titanium mesh cages and anterior plating. Spine 30:1402–1406. doi:10.1097/01.brs.0000166526.78058.3c

    Article  PubMed  Google Scholar 

  13. DiAngelo DJ, Foley KT, Vossel KA et al (2000) Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine 25:783–795. doi:10.1097/00007632-200004010-00005

    Article  CAS  PubMed  Google Scholar 

  14. Emery SE, Bohlman HH, Bolesta MJ et al (1998) Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up. J Bone Joint Surg Am 80:941–951. doi:10.1302/0301-620X.80B6.9517

    Article  CAS  PubMed  Google Scholar 

  15. Epstein NE (2000) Anterior cervical diskectomy and fusion without plate instrumentation in 178 patients. J Spinal Disord 13:1–8. doi:10.1097/00002517-200002000-00001

    Article  CAS  PubMed  Google Scholar 

  16. Fernyhough JC, White JI, LaRocca H (1991) Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 16:S561–S564

    Article  CAS  PubMed  Google Scholar 

  17. Foley KT, DiAngelo DJ, Rampersaud YR et al (1999) The in vitro effects of instrumentation on multilevel cervical strut-graft mechanics. Spine 24:2366–2376. doi:10.1097/00007632-199911150-00014

    Article  CAS  PubMed  Google Scholar 

  18. Gercek E, Arlet V, Delisle J et al (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12:513–516. doi:10.1007/s00586-003-0539-6

    Article  PubMed  Google Scholar 

  19. Gonugunta V, Krishnaney AA, Benzel EC (2005) Anterior cervical plating. Neurol India 53:424–432

    Article  CAS  PubMed  Google Scholar 

  20. Gore DR, Sepic SB (1984) Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine 9:667–671. doi:10.1097/00007632-198410000-00002

    Article  CAS  PubMed  Google Scholar 

  21. Groff MW, Sriharan S, Lee SM et al (2003) Partial corpectomy for cervical spondylosis. Spine 28:14–20. doi:10.1097/00007632-200301010-00005

    Article  PubMed  Google Scholar 

  22. Hacker RJ, Cauthen JC, Gilbert TJ et al (2000) A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:2646–2655. doi:10.1097/00007632-200010150-00017

    Article  CAS  PubMed  Google Scholar 

  23. Hwang SL, Lin CL, Lieu AS et al (2004) Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation. J Neurosurg Spine 1:160–167

    Article  PubMed  Google Scholar 

  24. Katsuura A, Hukuda S, Imanaka T et al (1996) Anterior cervical plate used in degenerative disease can maintain cervical lordosis. J Spinal Disord 9:470–476. doi:10.1097/00002517-199612000-00003

    Article  CAS  PubMed  Google Scholar 

  25. Kirkpatrick JS, Levy JA, Carillo J et al (1999) Reconstruction after multilevel corpectomy in the cervical spine. A sagittal plane biomechanical study. Spine 24:1186–1191. doi:10.1097/00007632-199906150-00003

    CAS  Google Scholar 

  26. Liao JC, Niu CC, Chen WJ et al. (2007) Polyetheretherketone (PEEK) cage filled with cancellous allograft in anterior cervical discectomy and fusion. Int Orthop Epub ahead of print

  27. Lind BI, Zoega B, Rosen H (2007) Autograft versus interbody fusion cage without plate fixation in the cervical spine: a randomized clinical study using radiostereometry. Eur Spine J 16:1251–1256. doi:10.1007/s00586-007-0337-7

    Article  PubMed  Google Scholar 

  28. Macdonald RL, Fehlings MG, Tator CH et al (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:990–997

    Article  CAS  PubMed  Google Scholar 

  29. Majd ME, Vadhva M, Holt RT (1999) Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24:1604–1610. doi:10.1097/00007632-199908010-00016

    Article  CAS  PubMed  Google Scholar 

  30. McAfee PC, Bohlman HH, Ducker TB et al (1995) One-stage anterior cervical decompression and posterior stabilization. A study of one hundred patients with a minimum of two years of follow-up. J Bone Joint Surg Am 77:1791–1800

    CAS  PubMed  Google Scholar 

  31. Metzger CS, Schlitt M, Quindlen EA et al (1989) Small central cervical disc syndrome: evaluation and treatment of chronic disabling neck pain. J Spinal Disord 2:234–237. doi:10.1097/00002517-198912000-00004

    Article  CAS  PubMed  Google Scholar 

  32. Moreland DB, Asch HL, Clabeaux DE et al (2004) Anterior cervical discectomy and fusion with implantable titanium cage: initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 4:184–191. doi:10.1016/j.spinee.2003.05.001

    Article  PubMed  Google Scholar 

  33. Nirala AP, Husain M, Vatsal DK (2004) A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression. Br J Neurosurg 18:227–232. doi:10.1080/02688690410001732643

    Article  CAS  PubMed  Google Scholar 

  34. Omeis I, DeMattia JA, Hillard VH et al (2004) History of instrumentation for stabilization of the subaxial cervical spine. Neurosurg Focus 16:E10. doi:10.3171/foc.2004.16.1.11

    Article  PubMed  Google Scholar 

  35. Orr RD, Zdeblick TA (1999) Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop Relat Res 359:58–66. doi:10.1097/00003086-199902000-00007

    Article  PubMed  Google Scholar 

  36. Peelle MW, Rawlins BA, Frelinghuysen P (2007) A novel source of cancellous autograft for ACDF surgery: the manubrium. J Spinal Disord Tech 20:36–41. doi:10.1097/01.bsd.0000211230.89554.5c

    Article  PubMed  Google Scholar 

  37. Perez-Cruet MJ, Samartzis D, Fessler RG (2006) Anterior cervical discectomy and corpectomy. Neurosurgery 58:355–359. doi:10.1227/01.NEU.0000205285.20336.C2

    Article  Google Scholar 

  38. Rish BL, McFadden JT, Penix JO (1976) Anterior cervical fusion using homologous bone grafts: a comparative study. Surg Neurol 5:119–121

    CAS  PubMed  Google Scholar 

  39. Samartzis D, Shen FH, Goldberg EJ et al (2005) Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? Spine 30:1756–1761. doi:10.1097/01.brs.0000172148.86756.ce

    Article  PubMed  Google Scholar 

  40. Samartzis D, Shen FH, Matthews DK et al (2003) Comparison of allograft to autograft in multilevel anterior cervical discectomy and fusion with rigid plate fixation. Spine J 3:451–459. doi:10.1016/S1529-9430(03)00173-6

    Article  PubMed  Google Scholar 

  41. Sasso RC, Ruggiero RA Jr, Reilly TM et al (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine 28:140–142. doi:10.1097/00007632-200301150-00009

    Article  PubMed  Google Scholar 

  42. Schmieder K, Wolzik-Grossmann M, Pechlivanis I et al (2006) Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine 4:447–453. doi:10.3171/spi.2006.4.6.447

    Article  PubMed  Google Scholar 

  43. Silber JS, Anderson DG, Daffner SD et al (2003) Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:134–139. doi:10.1097/00007632-200301150-00008

    Article  PubMed  Google Scholar 

  44. Singh K, Vaccaro AR, Kim J et al (2003) Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine 28:2352–2358. doi:10.1097/01.BRS.0000085344.22471.23

    Article  PubMed  Google Scholar 

  45. Singh K, Vaccaro AR, Kim J et al (2004) Enhancement of stability following anterior cervical corpectomy: a biomechanical study. Spine 29:845–849. doi:10.1097/00007632-200404150-00005

    Article  PubMed  Google Scholar 

  46. Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A:607–624

    CAS  PubMed  Google Scholar 

  47. Stewart TJ, Schlenk RP, Benzel EC (2007) Multiple level discectomy and fusion. Neurosurgery 60:S143–S148. doi:10.1227/01.NEU.0000217015.96212.1B

    Article  PubMed  Google Scholar 

  48. Swank ML, Lowery GL, Bhat AL et al (1997) Anterior cervical allograft arthrodesis and instrumentation: multilevel interbody grafting or strut graft reconstruction. Eur Spine J 6:138–143. doi:10.1007/BF01358747

    Article  CAS  PubMed  Google Scholar 

  49. Takeshita K, Murakami M, Kobayashi A et al (2001) Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2–7). J Orthop Sci 6:223–226. doi:10.1007/s007760100038

    Article  CAS  PubMed  Google Scholar 

  50. Thalgott JS, Xiongsheng C, Giuffre JM (2003) Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating. Spine J 3:294–300. doi:10.1016/S1529-9430(02)00588-0

    Article  PubMed  Google Scholar 

  51. Thome C, Krauss JK, Zevgaridis D (2004) A prospective clinical comparison of rectangular titanium cages and iliac crest autografts in anterior cervical discectomy and fusion. Neurosurg Rev 27:34–41. doi:10.1007/s10143-003-0297-2

    Article  PubMed  Google Scholar 

  52. Thorell W, Cooper J, Hellbusch L et al (1998) The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery 43:268–274. doi:10.1097/00006123-199808000-00050

    Article  CAS  PubMed  Google Scholar 

  53. Troyanovich SJ, Stroink AR, Kattner KA et al (2002) Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech 15:69–74

    PubMed  Google Scholar 

  54. Tumialan LM, Rodts GE (2007) Adverse swelling associated with use of rh-BMP-2 in anterior cervical discectomy and fusion. Spine J 7:509–510. doi:10.1016/j.spinee.2007.03.005

    Article  PubMed  Google Scholar 

  55. Vaccaro AR, Falatyn SP, Scuderi GJ et al (1998) Early failure of long segment anterior cervical plate fixation. J Spinal Disord 11:410–415

    CAS  PubMed  Google Scholar 

  56. van den Bent MJ, Oosting J, Wouda EJ et al (1996) Anterior cervical discectomy with or without fusion with acrylate. A randomized trial. Spine 21:834–840. doi:10.1097/00007632-199604010-00011

    Google Scholar 

  57. Wang JC, Hart RA, Emery SE et al (2003) Graft migration or displacement after multilevel cervical corpectomy and strut grafting. Spine 28:1016–1022. doi:10.1097/00007632-200305150-00011

    Article  PubMed  Google Scholar 

  58. Wang JC, McDonough PW, Endow KK et al (2000) Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine 25:41–45. doi:10.1097/00007632-200001010-00009

    Article  CAS  PubMed  Google Scholar 

  59. Wang JC, McDonough PW, Endow KK et al (2001) A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion. J Spinal Disord 14:222–225. doi:10.1097/00002517-200106000-00006

    Article  CAS  PubMed  Google Scholar 

  60. Ying Z, Xinwei W, Jing Z et al (2007) Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy: a randomized control clinical study. Spine 32:1482–1487. doi:10.1097/BRS.0b013e318068b30a

    Article  PubMed  Google Scholar 

  61. Yonenobu K, Fuji T, Ono K et al (1985) Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:710–716. doi:10.1097/00007632-198510000-00004

    Article  CAS  PubMed  Google Scholar 

  62. Zaveri GR, Ford M (2001) Cervical spondylosis: the role of anterior instrumentation after decompression and fusion. J Spinal Disord 14:10–16. doi:10.1097/00002517-200102000-00003

    Article  CAS  PubMed  Google Scholar 

  63. Zdeblick TA, Bohlman HH (1989) Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am 71:170–182

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors acknowledge Katheryne Downes, M.P·H., for her assistance in statistical data analysis. No external sources of funding. No commercial interest in any of the devices mentioned in the article by any of the authors.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, USF Health South Center, Tampa, FL, 33606, USA

    Juan S. Uribe, Jaypal Reddy Sangala, Edward A.M. Duckworth & Fernando L. Vale

Authors
  1. Juan S. Uribe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jaypal Reddy Sangala
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edward A.M. Duckworth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fernando L. Vale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fernando L. Vale.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Uribe, J.S., Sangala, J.R., Duckworth, E.A. et al. Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J 18, 654–662 (2009). https://doi.org/10.1007/s00586-009-0897-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-009-0897-9

Keywords

Search

Navigation