COST ADVANTAGES OF 2-LEVEL ANTERIOR CERVICAL FUSION WITH RIGID INTERNAL-FIXATION FOR RADICULOPATHY AND DEGENERATIVE DISEASE

BACKGROUND Conventional anterior cervical discectomy with fusion is th ought to require postoperative neck immobilization for the promotion o f bony fusion. Rigid internal fixation with anterior cervical plates m ay decrease graft-related complications and provide immediate stabilit y. This stability may obviate postoperative external immobilization. M ETHODS This report reviews one surgeon's experience with the use of ri gid internal fixation for two-level anterior cervical discectomy and f usion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwen t two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a s ingle surgeon (FJP) to evaluate the cost advantages and outcome of eac h procedure. All patients had clinical evidence of cervical radiculopa thy unresponsive to medical therapy with magnetic resonance imaging co nfirmation of the appropriate nerve root impingement. Thirty-nine pati ents underwent two-level Cloward allograft fusion using Synthes anteri or cervical locking plates, 25 underwent identical fusion without plat ing, Follow-up was 6 months to 4 years (mean, 31 months), RESULTS Twen ty-three of 25 patients in the nonplated group and 36 of 39 patients i n the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in e ach group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted wo rk (66 vs, 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CO NCLUSIONS Two-level anterior cervical discectomy and fusion with anter ior plating for radiculopathy is safe, effective, and seems to provide shouter convalescence compared with conventional anterior cervical di scectomy and fusion. Patients returned to unrestricted work sooner, th us reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The a uthors conclude that the increased cost of treatment for rigid interna l fixation is more than offset by the benefits of earlier mobilization . (C) 1997 by Elsevier Science Inc.