No Difference in Surgical Outcomes between Stand-Alone Devices and Anterior Plating for 1-2 level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis

Xu Tao; Abhijith V Matur; Seth Street; Geet Shukla; Julia Garcia-Vargas; Jay Mehta; Kelly Childress; Henry O Duah; Justin Gibson; Daryn Cass; Andrew Wu; Benjamin Motley; Joseph Cheng; Owoicho Adogwa

doi:10.1097/BRS.0000000000004813

No Difference in Surgical Outcomes between Stand-Alone Devices and Anterior Plating for 1-2 level Anterior Cervical Discectomy and Fusion: A 1:1 Exact Matched Analysis

Spine (Phila Pa 1976). 2023 Sep 4. doi: 10.1097/BRS.0000000000004813. Online ahead of print.

Authors

Affiliations

¹ Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
² Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH, USA.
³ Institute for Nursing Research & Scholarship, University of Cincinnati College of Nursing, Cincinnati, OH, USA.

PMID: 37661800
DOI: 10.1097/BRS.0000000000004813

Abstract

Study design: Retrospective cohort.

Objective: Compare rates of all-cause surgical and medical complications between zero-profile (stand-alone) implants versus any graft type with anterior plate in patients undergoing 1-2 level anterior cervical discectomy and fusion (ACDF) for treatment of degenerative cervical myeloradiculopathy.

Summary of background data: Degenerative cervical myeloradiculopathy is increasingly prevalent in older adults. ACDF is a common surgical procedure for decompression of neural structures and stabilization and has been shown to have excellent outcomes. While ACDFs performed with a graft and plate has been the gold standard, more recently, zero-profile implants were developed to decrease implant related complications, such as severe postoperative dysphagia. However, there is a paucity of papers comparing the surgical and medical complications profile of zero-profile (stand-alone) implants to grafts with plating systems.

Methods: Data was extracted from the PearlDiver Mariner Database using CPT codes to classify patients into 1-level, 2-levels, and total 1-2 level ACDFs. Patients undergoing surgery for non-degenerative pathologies such as tumors, trauma, or infection were excluded.

Results: 1:1 exact matching created two equal groups of 7,284 patients that underwent 1-2 level ACDF with either grafting with a plate or zero-profile (standalone) implant. There were no statistically significant difference in all-cause surgical complications, pseudarthrosis rate, dysphagia or need for revision surgery between both cohorts (RR 0.99, 95% CI 0.80-1.21, P = 0.95). Additionally, all-cause medical complications were similar between both cohorts (RR 1.07, 95% CI 0.862-1.330, P = 0.573) or any specific surgical or medical complication included in this study.

Conclusion: After 1:1 exact matching, the results of this study suggest that zero-profile (stand-alone) implants have similar outcomes compared to grafts with plating systems, with no observed differences in all-cause surgical or medical complications profile.