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Although stand-alone cages were advocated to be superior to plate-cage construct (PCC) because of comparable clinical outcomes and fewer plate-related complications, cage dislocation and subsidence were frequently mentioned in multilevel fusion. There are some concerns about whether these issues can be effectively prevented in multilevel anterior cervical discectomy and fusion (ACDF) by stand-alone anchored spacer (SAAS).The aim was to compare clinical outcomes, radiologic parameters, and complications of PCC and SAAS in the treatment of three-level cervical spondylotic myelopathy (CSM).This was a retrospective comparative study.A total of 38 consecutive patients with three-level CSM (ACDF with PCC, 20 patients; ACDF with SAAS, 18 patients) were reviewed.Clinical outcomes were assessed using Japanese Orthopaedic Association and Neck Disability Index. The radiologic evaluations included cervical alignment (CA), segmental angle (SA), postoperative curvature loss (PCL), and incidence of subsidence.All the aforementioned parameters were compared before and after surgery between two groups. Besides, the aforementioned results were also compared between the two groups. The complications were also recorded.The mean follow-up period was 30.3 months. No significant differences were observed in clinical outcomes between the two groups (p.05). Additionally, no significant differences existed in fusion rate between the two groups. There were significant differences in PCL of SA and CA and correction of SA between the two groups (p.05). Besides, the incidence of subsidence (9 of 54 levels, 16.7%) was recorded in the SAAS group, and the potential of SAAS to reduce the incidence of postoperative dysphagia was not proven. No other complications were observed in this study.In the surgical treatment of three-level CSM, PCC is superior to SAAS in correction and maintenance of SA and avoiding cage subsidence, although the technique of ACDF with SAAS yielded encouraging clinical outcomes and high fusion rate.

Background context The treatment of adolescent congenital deformity (late-diagnosed congenital deformity) is still unknown. The best candidates for hemivertebra excision are young patients, typically between 4 and 6 years of age. Partial excision may be feasible for older children. Purpose The purpose of this study was to assess the effect of unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity. Study design Retrospective analysis. Patient sample Twelve patients with adolescent congenital deformity who underwent posterior unilateral pedicle subtraction osteotomy and correction were evaluated. Mean age at the time of surgery was 17 years. Outcome measures The charts, standing full-length posteroanterior and lateral view radiographs, and functional measures were reviewed. Methods For evaluation of surgical effectiveness, comparative analysis of the parameters of the total main curve, the segmental curve, the compensatory cranial and caudal curves, the segmental kyphosis, and the trunk shift before and after operation and at the most recent follow-up was done. Results The mean follow-up period was 40.5 months. Mean Cobb angles of the total main curve and the segmental curve were, respectively, 47.5° and 43.8° before surgery, 23.7° and 16.5° after surgery, and 22.6° and 17° at the last follow-up. The angle of segmental kyphosis was 11.8° before surgery, 6.2° after surgery, and 7.8° (range, −30° to 26°) at the final follow-up. The mean final global lordosis was within the normal range. No neurologic deficit occurred. Solid fusion was achieved for all cases. Conclusions Unilateral pedicle subtraction osteotomy with instrumentation from a posterior-only approach is indicated in older teenagers for an adolescent congenital spinal deformity. Compared with hemivertebra excision, corrective surgery with hemivertebra osteotomy has a lower intraoperative blood loss and shorter operation time.