Is It Necessary To Place Screws In The Intervening Vertebrae In Two-Level Anterior Cervical Discectomy With Fusion And Plating?

BackgroundAnterior cervical discectomy with fusion and plating(ACDF)is a common method for treating two levels of anterior cervical spondylotic conditions.However,there is no uniform data on the necessity of screw placement in the intermediate vertebra for 2-level ACDF.The clinical efficacy comparing the two methods has not been fully investigated.ObjectiveThe clinical outcomes,radiological parameters,complication rate and the cost of implants in two-level ACDF with and without screws in the intervening segment were compared.The aim is to provide a reference for clinical treatment of screw placement.MethodA retrospective study of 151 patients who underwent 2-level ACDF from January 2014 to December 2016 was performed.The patients were divided into two groups:Intermediate vertebra with screw group and Intermediate vertebra without screw group.Perioperative factors,clinical outcomes,postoperative complications,radiological parameters,and cost of the implants were evaluated in both groups.ResultsThe Japanese Orthopaedic Association(JOA)score of the two groups after operation was significantly higher than that of the group before operation(*P<0.05,**P<0.05);and the scores of Visual Analogue Scale(VAS)and Neck Disability Index(NDI)in the both groups were significantly lower than those before operation(*P<0.05,**P<0.05;φPP<0.05,φφP<0.05).No statistical differences in JOA、VAS、NDI,operative blood loss,hospital stay,restoration of cervical lordosis or segment height,postoperative complications were found between the two groups during the preoperative and postoperative follow-up(P>0.05).The fusion rates of Intermediate vertebra with screw group and Intermediate vertebra without screw group were 87.9%and 91.4%,respectively.There was no significant difference between the two groups(P>0.05).The screw placement time and cost of implants in the Intermediate vertebra with screw group and Intermediate vertebra without screw group were(16.55 ± 2.28)、(12.83±2.87)min and(4.17 ± 0.05)、(3.85±0.02)x 10000 RMB,respectively.There were significant difference in the screw placement time and cost of implants between the two groups(P<0.05).ConclusionThe results of our study show that plating with or without screws in the intervening vertebra in 2-level ACDF has similar clinical outcomes.And two kinds of screw placement with ACDF were found no difference in terms of operative blood loss,hospital stay,restoration of cervical lordosis or segment height,postoperative complications and fusion rate.However,the ACDF without intervening screw placement has shorter screw placement time and lower implant costs.