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Outcomes of anterior cervical discectomy and fusion with cage and plate construct in patients with traumatic cervical spine injury
Conference poster   Peer reviewed

Outcomes of anterior cervical discectomy and fusion with cage and plate construct in patients with traumatic cervical spine injury

Jahan Aslami, Brianne Giuffrida, Shahed Elhamdani, Navya Dandu, Alexander Whiting, Alexander Yu and Daniel T. Altman
The spine journal, v 25(11), pp S136-S137
Nov 2025
DOI: https://doi.org/10.1016/j.spinee.2025.08.132

Abstract

BACKGROUND CONTEXT Anterior cervical discectomy and fusion (ACDF) has become a gold standard procedure for treatment of degenerative cervical spine disease due to its favorable complication profile and high rates of fusion. Utilizing this approach for traumatic cervical spine injuries, however, has been debated in the literature. Anterior, posterior, or combined approaches can be selected based on fracture type and location. In traumatic cervical instability, ACDF is generally supplemented with posterior instrumentation for additional stability and to mitigate the risk of hardware failure. This can increase the risk of complications, add operative time/exposure, and may necessitate additional levels of fusion. A new technique utilizing the ACDF with a hybrid construct including a cage and plate may provide sufficient stability while negating complications associated with posterior approaches. PURPOSE This case series assesses the reliability of ACDF with a cage plate construct (CPC) in cases of traumatic cervical spine injury. STUDY DESIGN/SETTING N/A. PATIENT SAMPLE N/A. OUTCOME MEASURES N/A. METHODS Patient medical records at a single institution who underwent ACDF with CPC after cervical spine trauma were retrospectively reviewed. Patients without traumatic cervical spine instability were excluded. The primary endpoint was hardware failure and return to the operating room. Patient demographics, co-morbidities, mechanism/type of injury, operative procedure and average follow up duration were also recorded. We used descriptive statistics to represent the data. RESULTS Fourteen patients (6 males and 8 females) met inclusion criteria, and the procedure was performed by 3 surgeons over a span of 4 years. Average age of the patient was 52 +/- 20.8 years with an average operative time of 134 +/- 74 minutes. Seven patients were injured from motor vehicle collisions while 7 were injured from falls. Eight patients sustained vertebral fractures, 3 had spondylolisthesis, 2 had disc herniations and 1 patient had a combination of spondylolisthesis and a disc herniation. Eleven patients underwent single level fusion while 3 underwent 2 level fusion. Eight out of 14 patients had a fusion at the C6/7 level. Five patients had significant co-morbidities including hypertension, heart failure, ESRD, COPD, diabetes, lupus and substance use disorder. Average follow up was 6.5 +/- 4.3 months. Two patients were immediately lost to follow up and were excluded from the average. Two other patients died from unrelated medical conditions before 6 months of follow up. Zero out of 14 patients suffered from hardware failure, peri-operative complications or returned to the operating room for additional spinal procedures. CONCLUSIONS ACDF in the context of traumatic spinal injury is often supplemented with posterior instrumentation to ensure a stable construct and avoid hardware failure. This combined approach increases the risk of perioperative complications due to increased operative time and multiple incision sites. Transferring the patient into the prone position intraoperatively also increases the risk of inadvertent injury. Importantly, posterior operations may require more extensive levels of fusion which ultimately reduces the patients range of motion while ACDF with CPC only involves the injured level. The results of our case series provide evidence for the safety and efficacy of ACDF with CPC without the need for posterior instrumentation. All patients in our study had stable constructs in the immediate post-operative period and sustained no peri-operative complications. With longer follow up, rates of successful fusion can also be determined. Normalizing this technique will lead to larger studies that may further support our findings. Future studies could better characterize the utility of ACDF with CPC in the context of specific injury patterns.

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