Three and Four Levels Anterior Cervical Discectomy and PEEKCage Fusion Alone in Treatment of Cervical Degenerative Radiculomyelopathy

Abstract
Background: Anterior Cervical Discectomy and Fusion (ACDF) is the commonest procedure used in treatment of degenerative cervical radiculomyelopathy, and the use of spinal cages with auto graft helps in increasing foraminal height, and regaining the lordotic cervical curvature, besides it gives high rate of fusion with less complications.
Aim of the Study: To evaluate the safety and efficacy of three and four levels ACDF with PEEK cages only without plating, and to assess the clinical and radiologic outcome.
Study Design: This non randomized non controlled clinical trial case series of seventeen patients, their aged 42 to 73 years of age with cervical degenerative radiculomyelopathy who were treated with three or four ACDF with PEEK cage fusion which were done at Neurosurgery Department of Benha University Hospitals during the period from 2011 to 2016, With mean follow-up 18.6 months.
Patients and Methods: Ten males and seven females, of them four cases with cervical spondylotic myelopathy, and thirteen cases with radiculopathy were included. Patients were clinically evaluated using Visual Analogue Score (VAS) for pain and Neck Disability Index (NDI), and radiologically evaluated for neck curvature, fusion rate in lateral radiographs.
Results: Five cases underwent four levels ACDF, and twelve cases underwent 3 levels ACDF with a total of 56 levels operated upon. As regard clinical state there was a statistically significant improvement in VAS in neck and arm pain (p<0.001), and also in NDI (p<0.001). All cases with myelopathy had significant satisfactory improvement in spasticity with improved ability. As regard radiology 82.4% of patients had good fusion, significant improvement in lordotic curve (from mean of 7.6º to 16.2º) and increased disc height.
Conclusion: Three and four levels ACDF with PEEK cage alone without plating in treatment of degenerative cervical radiculomyelopathy is safe and effective and had good clinical outcome with low complication, and good radiologic outcome with excellent fusion rate, restoring the lordotic curve and increasing and maintaining disc height.