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

BACKGROUND: Anterior cervical discectomy and fusion with plate stabilization (ACDF+PS) is an accepted surgical procedure. We sought to evaluate the long-term clinical results of ACDF+PS with a 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 neurologic status, Neck Disability Index, EuroQuol-5 Dimension, Patient Satisfaction Index, Hospital Anxiety and Depression Scale, the Odom 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, and 74 (53.2%) did not participate. Forty-six patients attended a physical examination. ACDF+PS were performed at 1 level in 28 patients, at 2 levels in 29 patients, and at 3 levels in 8 patients. Fifty (83.3%) of the patients with preoperative pain remained free of pain and did not require another procedure as the result of degenerative cervical disease. The mean NDI was 14%; according to the Odom criteria 86.2% of patients reported good-to-excellent functional recovery. A total of 100% of patients were satisfied or very satisfied with their outcome and would decide to undergo ACDF+PS again. Two developed adjacent segment disease 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 was 4.5% after 20 years' follow-up.