Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-Alone Cage and Conventional Cage-Plate Construct: a 5-year Retrospective Cohort Study

Study Design/Setting. A retrospective cohort study. Objective. To evaluate the clinical efficacy of the self-locking stand-alone cage (SA) and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a 5-year follow-up. Summary of Background Data. The stand-alone approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion (ACDF). These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of stand-alone cage is limited. Methods. We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed. Results. In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 months and 60.9 months. Both groups exhibited significant improvements in all measured values compared to the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group ( P <0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively ( P =0.365). The radiographic ASD was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P <0.01). No symptomatic ASD was observed in the SA group, and 6 (5.7%) cases occurred in the CPC group ( P =0.029). Conclusion. In this study of the Asian population, the stand-alone cage showed similar efficacy to that of the conventional cage-plate construct in treating cervical spondylosis with ACDF, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.