Evaluating the Safety and Efficacy of Stand-Alone Locking Cage in Single- and Multi-Level Anterior Cervical Discectomy and Fusion in the hands of a young Neurosurgeon: A Retrospective Study of 125 Cases

Abstract

Objective:  Cervical degenerative spondylosis often requires surgical intervention after failed conservative management. Zero-profile stand-alone cages for anterior cervical discectomy and fusion (ACDF) offer stability with reduced implant bulk. This study evaluates clinical outcomes, fusion success, and determinants of outcomes following single- and multi-level ACDF using this technique.

Materials and Methods:  This retrospective cohort Study of 125 patients undergoing ACDF with a zero-profile stand-alone cage was conducted at Swat Medical Complex Teaching Hospital and Swat Medical College, Swat, KPK. Clinical outcomes (Neck Disability Index, Visual Analogue Scale for pain, modified Japanese Orthopaedic Association score) and radiological fusion were assessed preoperatively and at 3, 6, and 9 months. Predictors of fusion failure and functional improvement were identified using multivariable regression analyses.

Results:  Mean age was 49.2±8.7 years; 55.2% were male. Significant improvements occurred across all measures (p<0.001). Fusion rates were 90.1%, 80.0%, and 66.7% for single-level, two-level, and three-level procedures, respectively (trend p=0.015). Independent predictors of fusion failure were current smoking (odds ratio 3.35), multi-level surgery (odds ratio 3.74), and osteoporosis (odds ratio 4.66). Multi-level surgery was associated with significantly less Neck Disability Index improvement (3.21 points, p=0.002). The overall complication rate was 17.6%.

Conclusion:  Zero-profile stand-alone cage ACDF is effective and safe, yielding high fusion rates and significant clinical improvement. Success is influenced by smoking, multi-level surgery, and osteoporosis, emphasizing the importance of patient selection and preoperative optimization.