Comparative clinical outcomes of ACDF with self-locking cage, cage combined with plate, and posterior laminoplasty in long-level cervical spondylosis: a two-year follow-up study.

BACKGROUND

This study aimed to compare the clinical efficacy of anterior cervical discectomy and fusion (ACDF) with self-lock cage through mini-incision, ACDF with cage and plate, and posterior laminoplasty (LAMP) for long-level cervical spondylosis without severe ossification of posterior longitudinal ligament.

METHOD

From January 2018 to January 2021, patients diagnosed with 3-4 segments (C3-7) cervical spondylotic radiculopathy, cervical spondylotic myelopathy, or mixed cervical spondylosis underwent surgical treatment. The procedures included ACDF with self-lock cage through mini-incision (48 cases) (group A), ACDF with cage and plate (37 cases) (group B), and LAMP (40 cases) (group C). Surgical parameters such as operative time, blood loss, incision length, and hospital stay were documented. Additionally, measurements were taken for intervertebral height, functional segment height, cervical lordosis, cervical hyperextension and hyperflexion range-of-motion (ROM), and ROM in all directions of the cervical spine before and after surgery. The therapeutic outcomes of both groups were evaluated, and any postoperative complications were meticulously recorded.

RESULTS

There was no significant difference in gender, age, JOA, VAS score of upper limb, NDI score, preoperative cervical intervertebral height, functional segment height, lordosis angle, cervical ROM, hyperextension and hyperflexion ROM was observed among three groups. The patients in group A and group B had less bleeding, shorter incision, and fewer hospitalization days than group C (P < 0.05). The patients in group A had a shorter incision than those in group B (P < 0.05). Group A showed shortest operation time(A < B < C)(P < 0.05). There was no significant difference in JOA, VAS score of upper limb, NDI score after surgery among three groups. The restoration of postoperative intervertebral height, functional segment height, and cervical lordosis angle of group A and group B were significantly more than those of group C (P < 0.05). There was no significant difference between preoperative and postoperative ROM in all directions of cervical spine in three groups.

CONCLUSIONS

All three surgical techniques-self-locking cage ACDF, cage-and-plate ACDF, and LAMP-are effective options for treating long-level cervical spondylosis without severe OPLL. Among them, the self-locking cage technique offers distinct advantages, including smaller incisions, less surgical trauma, a lower risk of postoperative dysphagia, and a high fusion rate even in multilevel procedures.