Increased fusion rates with cervical plating for three-level anterior cervical discectomy and fusion

Study Design. A retrospective review of all patients surgically treated by a single surgeon with a three-level anterior cervical discectomy and fusion with and without anterior plate fixation. Objectives. To compare the clinical and radiographic success of anterior th ree-level discectomy and fusion performed with and without anterior cervica l plate fixation. Summary of Background Data. Previous studies of multilevel cervical discect omies and fusions have shown fusion rates to decrease as the number of surg ical levels increases. Anterior cervical plate stabilization can provide mo re stability and may increase fusion rates for multilevel fusions. Methods. Over a 7-year period, 59 patients were treated surgically with a t hree-revel anterior cervical discectomy and fusion by the senior author. Fo rty patients had-cervical plates, whereas 19 had fusions with no plates. Th ese patients were observed for an average of 3.2 years. Clinical and radiog raphic follow-up data were obtained. Results. Of the 59 patients, 14 had a pseudarthrosis (7 in each group). The pseudarthrosis rates were 18% (7 of 40) for patients with plating and 37% (7 of 19) for patients with no plating. Although the nonunion rate for unpl ated fusions was double that of plated fusions, this difference was not sta tistically significant. There was no statistically significant correlation between pseudarthrosis and gender, age, lever of surgery, history of tobacc o use, or previous anterior surgery. The fusion rates were improved with th e use of a cervical plate. Inferior clinical results were demonstrated in p atients with a pseudarthrosis, regardless of the use of a cervical plate. Conclusions. The addition of plate fixation for three-level anterior cervic al discectomy and fusion is a safe procedure and does not result in higher complication rates. In this study, the pseudarthrosis rate was lower for pa tients with a cervical plate. However, this difference was not statisticall y significant. Patients treated with cervical plating had overall better re sults when compared with those of patients treated without cervical plates. Although the use of cervical plates decreased the pseudarthrosis rate, a t hree-level procedure is still associated with a high nonunion rate, and oth er strategies to increase fusion rates should be explored.