OTS11 Outcomes after anterior cervical diskectomy and fusion with plating. (Orthopaedic & Trauma Surgery).

OTS11 OUTCOMES AFTER ANTERIOR CERVICAL DISKECTOMY AND FUSION WITH PLATING. Scott D. Hodges, DO, S. Craig Humphreys, MD, Jason C. Eck, MS, and Arnanda Winters, BS. Center for Sports Medicine and Orthopaedics, Chattanooga, Tenn.

Anterior cervical diskectomy with fusion for treatment of degenerative disk disease remains controversial. There is disagreement regarding whether a fusion with bone graft and plating is necessary or if diskectomy alone is sufficient. Proponents of diskectomy alone argue that similar outcomes can be achieved without the increased risk and cost associated with graft harvest and placement. Proponents of fusion argue that the bone graft is a necessary component to insure proper foraminal space, to prevent bone spurs, and to decrease pain. There is also controversy regarding the use of cervical plating devices to achieve fusion. The purpose of this study was to investigate the outcomes of patients receiving anterior cervical diskectomy with instrumented fusion in terms of pain and functional capacity improvements and radiographic evidence of fusion. Two orthopaedic spine surgeons performed single level anterior cervical diskectomy with instrumented fusion on 136 patients from January 1998 through December 1999. I ndications for surgery included degenerative disk disease, herniated disk with radiculopathy and single level spinal stenosis. Outcomes were assessed using preoperative and postoperative visual analog pain scales (VAS) and Oswestry functional capacity evaluations (OSW). Evidence of fusion was determined with flexion-extension radiographs. Of the 136 patients in the study, 74 (54%) were female, 62 (46%) were male, 12 (9%) were involved with workers' compensation, and 44 (32%) were smokers. All patients had radiographic evidence of fusion within 1 year of surgery, with most achieving fusion at 4 months. There were no infections or hardware complications, and no cases of dysphasia lasted longer than 1 month. Patients had a mean improvement of 56.6% in VAS and 48.0% in OSW scores after surgery. The results of this study suggest that anterior cervical diskectomy with fusion is an effective technique to achieve solid fusion and to improve pain and functional capacity in patients with degenerative disk disease. Whil e previous investigators have argued that plating is not necessary to achieve fusion, we argue that fusion can be achieved in a shorter time with the addition of a plate without significantly increasing the associated risk. All patients in the current study achieved solid fusion within 1 year, with most solidly fused within 4 months. The benefit of instrumented fusion is to allow patients to achieve pain relief and return to normal activities more quickly than if fusion was attempted without plating.