Anterior cervical diskectomy and fusion without plate instrumentation in 178 patients

Between 1989 and 1996, fusion, pseudarthrosis, repeated operation rates, and outcomes were studied in 178 patients undergoing one- to four-level (average, 2.2 levels) anterior cervical diskectomy and fusion (ADF) without plating. Dynamic radiographs taken 3 and 6 months after operation showed fusion or pseudarthrosis without motion in 99% of patients after one-level ADF (78 patients), in 90% after two-level ADF (84 patients), and in 100% after three-level ADF (12 patients) and four-level ADF (4 patients). Pseudarthrosis with motion was noted in 1% after one-level ADF and in 10% after two-level ADF (statistically significant with a lower pseudarthrosis rate in the 1-level; by Fisher's exact test, p = 0.0351). Three patients required secondary posterior wiring and fusion. Good or excellent outcomes (by Odom's criteria) were achieved in 96% of patients within an average of 82 months. Although fusion rates for one-level ADF without plates appear adequate, high pseudarthrosis rates after two-level ADF warrant that plating be considered.