J Neurol Surg A Cent Eur Neurosurg 2015; 76(03): 199-204
DOI: 10.1055/s-0034-1382782
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Outcome after Adjacent Two-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Plasmaphore-Covered Titanium Cages

Serge Marbacher
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
Teresa Hidalgo-Staub
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
Jenny Kienzler
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
Carola Wüergler-Hauri
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
Hans Landolt
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
Javier Fandino
1   Department of Neurosurgery, Kantonsspital Aarau (KSA), Aarau, Switzerland
› Author Affiliations
Further Information

Publication History

04 November 2013

11 February 2014

Publication Date:
29 July 2014 (online)


Background Reports on long-term outcome of stand-alone contiguous two-level anterior cervical discectomy and fusion (ACDF) using stand-alone Plasmaphore-coated titanium cages (PCTCs) are rare, and data on follow-ups > 3 years are missing.

Objective To evaluate the long-term outcome of adjacent two-level microsurgical ACDF using stand-alone PCTC.

Patients/Material and Methods A total of 33 consecutive patients presented with cervical degenerative disc disease (DDD) underwent contiguous two-level ACDF. Clinical long-term evaluation (mean: 61 ± 14 months) included documentation of neurologic deficits (motor deficits, sensory deficits, reflex status, and gait disturbance), neck pain, and radicular pain. Functional outcome was measured using the Odom criteria, patient-perceived outcome, and evaluation of work status. Radiographs were evaluated to assess intervertebral disc height, subsidence, level of fusion, sagittal balance, and implant position.

Results Surgery was performed at levels C5–C6 and C6–C7 in 30 patients and at C4–C5 and C5–C6 in 3 (mean age: 50.1 ± 7.7 years). Symptoms and neurologic deficits improved as follows: neurologic deficits (pre: 100%; post: 36%), radicular pain (pre: 85%; post: 15%), and neck pain (pre: 94%; post: 33%). Excellent and good functional and subjective outcome was noted in 75%. Cage subsidence was found to be more prominent in the lower (52%) than the upper (36%) mobile cervical segment. Two-level fusion was documented in most patients (n = 29 [88%]). Kyphotic deformity occurred in two cases (n = 2 [6%]).

Conclusions Stand-alone contiguous two-level ACDF using PCPT proved to be effective, yielding good long-term clinical and functional outcomes. The relatively high rate of subsidence did not affect the good clinical and functional long-term outcome.

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