Smith-Robinson Procedure with an Autologous Iliac Crest Graft and Caspar Plating: Report of 65 Patients With an Average Follow-up of 22 years

Abstract Backround Anterior cervical discectomy and fusion with plate stabilization (ACDF+PS) is an accepted surgical procedure. The purpose was to evaluate the long-term clinical results of anterior cervical discectomy and fusion with plate stabilization with special focus on pain, functional outcome and adjacent segment disease. Methods Retrospectively 139 patients who underwent ACDF+PS were reviewed with a standardized questionnaire including the current neurological status, Neck Disability Index (NDI), EuroQuol-5 Dimension (EQ-5D), Patient Satisfaction Index (PSI), Hospital Anxiety and Depression Scale (HADS), Odom`s criteria, complications at the iliac crest donor side and limitations in quality of life. Results Mean follow-up time was 22 years (range: 17-34 years). Sixty five (46.8%) patients were evaluated by completed questionnaires, 74 (53.2%) did not participate. Forty-six patients attended a physical examination. ACDF+PS were performed at one level in 28 patients, at two levels in 29 patients, and at three levels in 8 patients. Fifty (83.3%) of the patients with preoperative pain remained free of pain and did not require another procedure due to degenerative cervical disease. The mean NDI was 14%, according to Odom`s criteria 86.2% of patients reported good to excellent functional recovery. 100% of patients were satisfied or very satisfied with their outcome and would decide to undergo ACDF+PS again. Two developed adjacent segment disease (ASD) and needed a second procedure Conclusions ACDF+PS resulted in a significant increase in function, pain relief and to a high degree of patient satisfaction. The rate for symptomatic adjacent segment disease (ASD) was 4.5% after 20 years follow-up.