Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages

Study Design: This is a retrospective study with a minimum follow-up of 2 years. Purpose: The aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages. Overview of Literature: Over the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. How- ever, research on their application in the treatment of four-level diseases is insufficient. Methods: In this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using stand- alone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Ana- log Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage. Results: The mean follow-up was 47 +/- 11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4 +/- 9.3 at presentation to 8.3 +/- 6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5 degrees preoperatively to a mean of 15 degrees postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm. Conclusions: Overall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.