Eleven-Year Follow-Up of Two Cohorts of Patients Comparing Stand-Alone Porous Tantalum Cage Versus Autologous Bone Graft and Plating in Anterior Cervical Fusions.

Abstract

Anterior cervical discectomy and fusion with a porous tantalum cage is an accepted method to treat degenerated cervical discs, with good results, similar to those with autologous bone graft and plating at short- and mid-term follow-up. However, to date, long-term follow-up studies have been performed. We performed a retrospective, single-center study to evaluate the outcomes of 2 cohorts from a previous prospective randomized controlled trial comparing stand-alone tantalum cage (group 1, 27 patients) with autologous bone graft and plating (group 2, 30 patients) for single-level anterior cervical discectomy and fusion at 11 years of follow-up. The usual clinical and radiological outcomes and "overall success," proposed by the Food and Drug Administration, were evaluated. The improvement in clinical outcomes achieved postoperatively was maintained similarly in the 2 cohorts at 11 years of follow-up. In group 1, the cage had subsided 2-3 mm in 12 patients (44%), segmental lordosis was maintained in 16 patients (59%), adjacent segment degeneration had developed or progressed in 27 of the adjacent segments (50%) in 15 patients (56%), and postoperative nonprogressive deformation of the anterior aspect of the cage was observed in 7 (26%) and minor fragmentation in 3 (11%) patients. In group 2, segmental lordosis was maintained in 90% of the patients and adjacent segment degeneration had developed or progressed in 15 patients (50%). These results show that the clinical and radiological outcomes achieved at mid-term follow-up using a tantalum cage for single-level anterior cervical discectomy and fusion will be maintained for 11 years postoperatively, similar to the results with autologous bone graft and plating.