232. Standalone cages vs cage and plate constructs for primary one- and two-level anterior cervical discectomy and fusion: a prospective randomized controlled trial

• Published in: The spine journal 2021-09, Vol.21 (9), p.S119-S119
• Main Authors: Zavras, Athan, Siyaji, Zakariah, Piracha, Ali, Qadri, Talha, Nolte, Michael T., Sayari, Arash, Singh, Kern, Colman, Matthew
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.439

Although anterior cervical discectomy and fusion (ACDF) with interbody spacer and separate plate/screw construct (PLATE) is commonly performed, some have asserted it may be associated with a higher incidence of postoperative dysphagia, increased operative time, malpositioned hardware, higher costs, and adjacent segment impingement. To address these concerns, others have opted to utilize an interbody cage with integrated screws and no plate (CAGE) with good results. This study's purpose was to compare the perioperative and radiographic outcomes between stand-alone and anterior plated 1- and 2-level ACDF. Prospective randomized controlled trial. All procedures were performed by the senior surgeon between July of 2017 and February 2020. Patients with 1- to 2-level degenerative disease were randomized in a 1:1 ratio into one of two treatment arms consisting of either PLATE or stand-alone CAGE reconstruction. Patients were followed for a minimum of 1 year following surgical intervention. Primary endpoints assessed included clinical improvement on patient-reported outcome metrics (PROs), construct integrity, cervical alignment, successful arthrodesis, and subsequent revision surgeries. Statistical methods included chi-squared with Fisher's exact test for categorical variables and Mann-Whitney U-test or students t-test for continuous variables. The threshold for statistical significance was set to p .05. A total of 46 patients were randomized: 12 patients were treated with 1-level PLATE, 12 with 1-level CAGE, 12 with 2-level PLATE, and 10 with 2-level CAGE. For single-level ACDF, arthrodesis was observed in 90% of PLATE and 100% of CAGE patients (p = .305). There were no postoperative differences in PROs with the exception of worse swallow function on SWAL-QOL with PLATE at 6 weeks (71.3 SD:14.1 vs 87.9 SD: 11.1, p = .050) and 6 months (80.5 SD: 9.2 vs 92.1 SD: 7.9, p = .042). Pseudarthrosis requiring revision was observed in one PLATE patient. For two-level ACDF, arthrodesis was observed in 90% of PLATE and 80% of CAGE patients (p = .531). CAGE patients reported worse scores on NDI at 6-weeks (22.0 SD: 13.6 vs 52.0 SD: 25.6, p = .037) and 6-months (12.0 SD: 8.38 vs 39.3 SD: 21.3, p = .017), as well as on VAS Neck (0.96 SD: 0.6 vs 5.5 SD: 3.0, p = .010), but no differences in these parameters were seen at one year. However, swallow function was worse with PLATE on SWAL-QOL at 6 weeks postoperatively (76.54 SD: 7.3 vs 91.34 SD: 8.22, p = .038). There were no diffe