Background: The aim was to examine treatment strategies after injury of the lower cervical spine (C3-T1). The hypothesis was that ventral spondylodesis using cages and non-angular stable plates are before locked plates and tricortical bone graft.
Methods: This study was retrospective, case-controlled. During 01/2017 and 12/2019 all patients, with lower cervical spine fractures and instabilities of C3 to T1 were examined clinically and radiographically, for bony consolidation and stability after 3 and 12 months. Two groups were examined. In group, A stabilization was performed by angular stable plating and cage and in group B angular stable with additional bone graft interposition was performed. As for stability criteria, bony union and alignment of the spine were evaluated. Loss of stability, revision rate, and dysphagia were recorded.
Results: We included 77 patients stabilized by angular stable plates. Group A obtained 41 and group B 36. In group A, 30% were healed after 3 months, while none of the patients in group B were healed. In group B a healing rate of 66% was achieved after 12 months. After 3 and 12 months, patients of group A showed a significantly higher healing rate than in group B. All patients in group A showed good alignment, while in group B differences in the joint width occurred in 21%. Dysphagia occurred more often in group B than in Group A.
Conclusion: Faster healing and better alignment of cervical spine instabilities and fractures can be achieved by implantation of cages after angular stable plating. The risk for dysphagia can be also reduced by the implantation of cages.
Keywords: ACDF; Bone graft; Cage; Cervical spine; Surgery