Stand-alone cage neck fusions : a long-term review

Abstract

BACKGROUND : Anterior cervical decompression and fusion (ACDF) is a well-known treatment for persistent cervical radiculopathy or myelopathy. Fusion is performed to stabilise the segment, maintain foraminal height, and maintain the normal sagittal profile. The stand-alone cage concept, initiated by Bagby, has been used in the human spine since 1988. There are some concerns with stand-alone cages regarding expulsion and migration of the cage. AIM : To review the long-term outcome of stand-alone cage fusions done from 2000–2010 at 1 Military Hospital and describe our experience with this procedure. METHODS : A retrospective review of stand-alone cage neck fusion of 55 levels in 35 patients performed between January 2000 and December 2010 at 1 Military Hospital was done. Clinical notes and X-rays were reviewed. Fusion rate was assessed using standard X-rays with flexion/extension views. RESULTS : Seven patients (14%) had a non-union, giving a fusion rate of 86%. Five non-unions were painful. One patient had a revision for a painful non-union (NDI score: 35/50). One patient refused to have a revision at last visit despite having significant pain (NDI score: 27/50). One patient with a double level non-union has phaeochromocytoma with significant risk to revision and chose not to have the surgery (NDI score: 14/50). Two patients are on the waiting list for a revision in the near future (NDI scores: 24/50 and 19/50). The two remaining patients with non-unions are asymptomatic (NDI scores: 0/50 and 7/50). CONCLUSION : Stand-alone cage fusion is a safe and effective procedure providing a favourable clinical and radiological outcome. Good fusion rates can be obtained (86% in our study) with this method.