Stand-alone Cage for Three-level and Four-level Anterior Cervical Discectomy

Background: Anterior cervical discectomy and Polyetheretherketone cage fusion(ACDF) without fixation has proven to be safe and effective procedure for the treatmentof single and double-level degenerative disc disease (DDD). Three and four-level ACDFwithout fixation did not yet gain equal consensus. Objectives: This study aimed toevaluate the safety and effectiveness of three, and four-level PEEK cage fusion withoutfixation. Patients Methods: This study was conducted at Cairo University Hospitals,included eighteen patients suffering from myelopathy due to cervical DDD operatedupon by three-level (twelve patients) or four-level ACDF (six patients) without fixationfrom 2010 to 2012. Modified Japanese Orthopedic Association (mJOA) scoring was usedfor neurological assessment. Radiological assessment was done preoperative andpostoperative with a minimum of six months. Results: sixteen patients showed clinicalimprovement, two patients showed no change, none of patients showed clinicaldeterioration, complications occurred in one patient in the form of transient bilateral C5motor affection with subsequent improvement. Asymptomatic cage subsidence occurredwith three cages shortly postoperatively, with no further progression, and reoperationnot necessary. Conclusion: PEEK cage alone is a safe and effective surgical option inthe treatment of three and four-level cervical DDD.