Retrospective data analysis of anterior cervical discectomies and fusion without plate and screws

Abstract

Surgical intervention in cervical disease can relieve neurological symptoms and improve life quality. This study aimed to analyse retrospective data of microscope-assisted anterior cervical discectomy and fusion (ACDF) surgeries. The retrospective study was carried out at the ORTO clinic, Rīga, Latvia, from 2013 to 2017. Data from 198 patients were extracted retrospectively. Data on patient gender, age, diagnosis, extent of operation, type of cage and the overall height of the implants were used. Comparative analysis was carried out with the SPSS 22 software. P < 0.05 represented statistical significance. During the study period, 198 elective ACDF were carried out with increasing number of surgeries: 25 cases in 2013, 43 in 2014, 38 in 2015, 44 in 2016, and 48 in 2017. ACDF were significantly more often performed for females (n = 117, 59%) compared to males (n = 81, 41%; p < 0.003). Women were older with an average age of 50 ± 1 years than men (age 46 ±1; p = 0.007). The mean surgery time was 1.5 ± 1 hours and the mean hospitalisation time was 3 ± 1 days. Four types of cages were used in similar number of operation: Cervios Peek Chronos C (24%), Syncage C (21%), EIT 3D print (29%), Cervios C Peek (26%); p = 0.2, regardless of patient age or gender. Most often, in 98 cases, the overall height of implants was 6-10 mm. The maximal height was 22 mm, where two patients underwent three-level, and one had a four-level discectomy. The most prevalent disc lesion levels were C5/6 and C6/7, followed by C4/5 and C3/4. One- and two-level discectomies were performed in similar numbers: 95 and 81 cases. However, only 20 patients underwent three level and two patients had four level discectomies in 2016 and 2017. Two level discectomy at C5/6, C6/7 was carried out significantly more often for women (55 vs. 26; p = 0.01), and for men 1-level lesion was more common in C6/7; p = 0.04. The overall incidence of cage subsidence was 5.5%, and the highest incidence was 24% when a Syncage C was used. The ACDF appears to be performed increasingly more often, particularly, in females. The most frequent operation was in one or two cervical levels; in¬ cluding level C6/7 in both genders. In the last years, three- and four-level cervical discectomies have become one of the surgical opportunities. Choice of cage was not influenced by patient gen¬ der and age, while cage biophysical and biochemical properties may influence the choice.