Kingsley R. Chin, MD, Fabio J.R. Pencle, MB BS, Jason A. Seale, MB BS
Adjacent segment disease and dysphagia remain concerns of anterior cervical discectomy and fusion (ACDF) with fixation using anterior cervical plates (ACPs). The authors aim to demonstrate the feasibility, outcomes and fusion rate of a standalone PEEK cage in the outpatient setting.
The medical records of 48 consecutive patients undergoing single level standalone ACDF (S-ACDF) (Group 1) were compared to our control group of 49 patients who had single-level ACDF with ACP (Group 2). Outcomes assessed included VAS neck and arm, NDI scores, and radiation dose.
48 patients in Group 1 (S-ACDF) and 49 patients in Group 2 (ACDF-ACP). No statistical differences in gender, age or BMI were found between groups, p=0.286, 0.691 and 0.947 respectively. There was no intergroup statistically significant difference in preoperative and postoperative outcomes. Mean radiation dose in group 1 of 24.1+/-8.2mAS and 2.0+/-0.7mSv was significantly less compared to group 2 which was 29.8+/-5.4 and 2.5+/-0.5mSv, p<0.001. The average radiation dose for single level fusion in Group 1 was 15.6+/-1.5 mAs and 1.3+/-0.1mSv this is compared to average radiation dose in Group 2 of 27.8+/-3.9mAs and 2.3+/-0.3mSv, p=0.001. The average radiation dose for two level fusion in Group 1 was 30.9+/-3.5 mAs and 2.6+/-0.3mSv this is compared to average radiation dose in Group 2 of 33.9+/-6.0 and 2.9+/-0.5mSV, p=0.012.
In the outpatient setting, S-ACDF has shown statistically significant intergroup difference in overall radiation dose, as well as single and two-level fusions, (p<0.001). We conclude that S-ACDF can decrease overall radiation exposure to patients. This is comparable to single level ACDF-ACP in the outpatient setting.
About Author Dr. Kingsley R. Chin
Dr. Kingsley R. Chin is a board-certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology experience. He sees a niche opportunity where medicine, business and information technology meet and is uniquely experienced at the intersection of these three professions. He currently serves as Professor of Clinical and Biomedical Sciences at the Charles E. Schmidt School of Medicine at Florida Atlantic University and Professor of Clinical Orthopaedic Surgery at the Herbert Wertheim College of Medicine at Florida International University and has experience as Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School and Visiting Professor at the University of the West Indies.
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Scientific Paper Author & Citation Details
Kingsley R. Chin, MD1,2,3,Fabio J.R. Pencle, MB BS3, Jason A. Seale, MB BS3
1. Herbert Wertheim College of Medicine at Florida International University
2. Charles E. Schmidt College of Medicine at Florida Atlantic University
3. Less Exposure Surgery (LES) Society
4. Less Exposure Surgery Specialists Institute (LESS Institute).