Stand-Alone Cage with Integrated Fixation for Anterior Cervical Interbody Fusion in Cervical Degenerative Disease: Our Experiences

Background Anterior cervical discectomy and fusion is one of the most common operative treatments of degenerative disease of the cervical spine. Alternative to interbody fusion by way of unanchored bone-graft/cage or bone-graft/cage anchored with a plate is a standalone cage with integrated screws. Main potential benefits of standalone cage with integrated screws are lower incidence of postoperative dysphagia and higher immediate stability; however, outcomes and potential complications after interbody fusion with such cages were not adequately assessed yet.

Methods We analyzed 50 consecutive patients with cervical degenerative disease treated with anterior cervical discectomy and fusion with standalone cage with integrated screws (Zero-P, Synthes). Before and after surgery and then 3 and 12 to 24 months after surgery, we assessed the level of pain with visual analog scale (VAS), disability with neck disability index (NDI), severity of myelopathy with modified Japanese Orthopaedic Association scale (mJOA), and dysphagia with four level dysphagia scale. Position of the cage was assessed after surgery and 12 to 24 months after surgery with anteroposterior and lateral radiographs.

Results No complications occurred during or after surgery. The VAS score after surgery and then after 3 and 12 to 24 months was statistically significantly lower than before surgery (p < 0.05). The NDI was 12 to 24 months after surgery significantly lower than before surgery (p < 0.05). The mJOA scores were 12 to 24 months after surgery statistically significantly higher than before surgery (p < 0.05). We observed no cases of moderate or severe dysphagia. Position of the cage after surgery and then 12 to 24 months after surgery was good in all patients.

Conclusion Operative treatment of symptomatic cervical degenerative disease with anterior cervical discectomy and fusion using standalone cage with integrated screws is safe and efficient. Incidence of dysphagia after surgery is low and generally transient. Cage position was stable and no hardware failures were observed.