• Kyung-Jin Song, Byung-Wan Choi, Dong Hun Ham, and Kim Hyeong Jik HJ Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Korea..
• Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Korea.
• World Neurosurg. 2020 Feb 1; 134: e249-e255.

ObjectiveTo analyze hardware-related problems and their prognoses after anterior cervical discectomy and fusion (ACDF) using cages and plates for degenerative and traumatic cervical disc diseases.MethodsThe study included 808 patients who underwent anterior cervical discectomy and fusion for degenerative and traumatic disc diseases with >1 year of follow-up. We investigated time of onset and progression of problems associated with instrumentation and cage usage. The mean follow-up time was 3.4 years. Type of plate, range and level of fusion, patient factors (age, sex, body mass index, and bone mineral density), and local kyphosis were evaluated.ResultsComplications were found in 132 cases (16.5%), including subsidence in 69 cases, plate loosening in 8 cases, screw loosening in 8 cases, screw breakage in 1 case, and multiple complications in 36 cases. In 3 cases, additional posterior cervical surgery was performed. One case needed hardware revision. There were no esophageal, tracheal, or neurovascular structural injuries secondary to metal failure. There were no significant differences in type of plate, level of surgery, or patient factors. The greater the number of fusion segments, the greater the incidence of complications (P = 0.001). The clinical outcomes improved regardless of the complications (P = 0.083).ConclusionsMost hardware-related complications are not symptomatic and can be treated conservatively. Only a few cases need revision surgery. Precise surgical techniques are needed in multilevel anterior cervical discectomy and fusion (>3 levels) because of the increased complication rate.Copyright © 2019 Elsevier Inc. All rights reserved.

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