Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up

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  • 1 Department of Neurology, University of Campinas (Unicamp);
  • 2 Department of Neurosurgery, Federal University of São Paulo (Unifesp);
  • 3 Pontifical Catholic University of Campinas;
  • 4 Department of Neurosurgery, Pontifical Catholic University of Campinas; and
  • 5 Departments of Neurosurgery and
  • 6 Diagnostic Imaging, Federal University of São Paulo (Unifesp) Medical School, São Paulo, Brazil
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OBJECTIVE

The goal of this study was to evaluate the incidence of pseudarthrosis after the treatment of cervical degenerative disc disease (CDDD) with anterior cervical discectomy and fusion (ACDF) in which self-locking, stand-alone intervertebral cages filled with hydroxyapatite were used.

METHODS

The authors performed a retrospective cohort study of 49 patients who underwent 1- to 3-level ACDF with self-locking, stand-alone intervertebral cages without plates, with a minimum 2 years of follow-up. The following data were extracted from radiological and clinical charts: age, sex, time and type of pre- and postoperative signs and symptoms, pain status (visual analog scale [VAS]), functional status (Neck Disability Index [NDI]), history of smoking, bone quality (bone densitometry), and complications. Pseudarthrosis was diagnosed by a blinded neuroradiologist using CT scans. Clinical improvement was assessed using pre- and postoperative comparison of VAS and NDI scores. The Wilcoxon test for paired tests was used to evaluate statistical significance using a p value of < 0.05.

RESULTS

Three patients (6%) developed symptomatic pseudarthrosis requiring reoperation, with only 1 patient showing clinical worsening due to pseudarthrosis, while the other 2 with pseudarthrosis had associated disc disease at an adjacent level. The rate of symptomatic pseudarthrosis according to the number of operated levels was 0% for 1 level, 8.7% (2/23 patients) for 2 levels, and 7.7% (1/13 patients) for 3 levels. The total pseudarthrosis rate (including both symptomatic and asymptomatic patients) was 16.4%. Considering the clinical outcomes, there was a significant improvement of 75.6% in neck pain and 95.7% in arm pain, as well as a 64.9% improvement in NDI scores. Complications were observed in 18.4% of patients, with adjacent-level degenerative disease being the most prevalent at 14.3%.

CONCLUSIONS

ACDF with self-locking, stand-alone cages filled with a hydroxyapatite graft can be used for the surgical treatment of 1- to 3-level CDDD with clinical and radiological outcomes significantly improved after a minimum 2-year follow-up period. Comparative studies are necessary.

ABBREVIATIONS ACDF = anterior cervical discectomy and fusion; ASD = adjacent-segment disease; CDDD = cervical degenerative disc disease; HA = hydroxyapatite; NDI = Neck Disability Index; VAS = visual analog scale.

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Contributor Notes

Correspondence Eduardo A. Iunes: University of Campinas (Unicamp), São Paulo, Brazil. eduardo@dreduardoiunes.com.br.

INCLUDE WHEN CITING Published online July 31, 2020; DOI: 10.3171/2020.4.SPINE20357.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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