Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life

Abstract

Background: Anterior cervical discectomy and fusion (ACDF) constitutes the conventional treatment of cervical disc herniation due to degenerative disc disease (DDD). ACDF with plating presents a variety of complications postoperatively and stand-alone cages are thought to be a promising alternative. The aim of this study was firstly, to analyze prospectively collected data from a sample of patients treated with single ACDF using C-Plus self-locking stand-alone PEEK cage system, without the use of plates or screws, in order to evaluate pain levels of patients, utilizing Neck and Arm Pain scale as an expression of visual analogue scale (VAS). Secondly, we aimed to evaluate health-related quality of life, via the short-form 36 (SF-36) and Neck Disability Index (NDI).

Methods: Thirty-six patients (19 male and 17 female) with mean age 49.6±7 years old who underwent successful single ACDF using self-locking stand-alone PEEK cage for symptomatic cervical DDD were selected for the study. Neck and Arm pain, as well as SF-36 and NDI were estimated preoperatively and 1, 3, 6, and 12 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological and radiological evaluation.

Results: The clinical and radiological outcomes were satisfactory after a minimum 1-year follow-up. All results were statistically important (P<0.05), excluding improvement in NDI measured between 6 and 12 months. SF-36, Neck Pain, as well as Arm Pain featured gradual and constant improvement during follow-up, with best scores presenting at 12 months after surgery, while NDI reached its best at 6 months postoperatively.

Conclusions: Generally, all scores showed improvement postoperatively during the different phases of the follow-up. Subsequently, ACDF using C-Plus cervical cage constitutes an effective method for cervical disc herniation treatment, in terms of postoperative improvement on pain levels and health-related quality of life and a safe alternative to the conventional method of treatment for cervical DDD.

Keywords: Anterior cervical discectomy and fusion (ACDF); cervical degenerative disc disease (DDD); pain; quality of life; stand-alone cage.

Figure 1

Hand-drawn schematic illustration of the C-Plus webbed cervical cage.

Figure 2

Preoperative T2-weighted sagittal MRI revealing disc prolapse and spinal cord compression at the C5-C6 level. MRI, magnetic resonance imaging.

Figure 3

Postoperative lateral plain X-ray at 6 months presenting the implant with two vertical markers.

Figure 4

NDI, SF-36, neck pain and arm pain score progression at 1, 3, 6 and 12 months postoperatively. NDI, Neck Disability Index; SF-36, short-form 36.

Figure 5

Box plot representation of change of mean scores between the different phases of the follow-up regarding SF-36. SF-36, short-form 36. The asterisk (*) and circle (○) indicate a patient who represented an outlier in a phase of the follow-up.

Figure 6

Box plot representation of change of mean scores between the different phases of the follow-up regarding neck pain. The asterisk (*) and circle (○) indicate a patient who represented an outlier in a phase of the follow-up.

Figure 7

Box plot representation of change of mean scores between the different phases of the follow-up regarding arm pain. The asterisk (*) and circle (○) indicate a patient who represented an outlier in a phase of the follow-up.

Figure 8

Box plot representation of change of mean scores between the different phases of the follow-up regarding NDI. NDI, Neck Disability Index. The asterisk (*) and circle (○) indicate a patient who represented an outlier in a phase of the follow-up.