Comparison of Two-Screw versus Four-Screw Internal Fixation on Fusion Speed in Anterior Cervical Discectomy and Fusion: A Prospective Randomized Controlled Trial.
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Abstract
Background context: The insertion process of the new two-screw internal fixation is simpler than that of four-screw internal fixation for anterior cervical discectomy and fusion (ACDF). However, it is unclear whether there is a difference in fusion rate.
Purpose: This study aimed to compare the time required to achieve osseous fusion and the clinical efficacy of four-screw versus two-screw internal fixation.
Study design: Prospective randomized controlled trial.
Patient sample: From October 2021 to April 2023, eighty patients diagnosed with single-level cervical spondylosis were recruited and randomly allocated into a four- or two-screw group.
Outcome measures: The primary endpoint was the fusion rate six months postoperatively. Secondary outcomes included the prevalence of complications and patient-reported outcome measures (PROMs), including the Japanese Orthopaedic Association score, Neck Disability Index, and visual analog scale scores for arm and neck pain.
Methods: Patients were randomized to receive four-screw internal fixation (n=40) or two-screw internal fixation (n=40).
Results: A total of 77 patients completed the trial and were included in the analysis. No significant differences were observed between groups at baseline. The fusion rate in the two-screw group was significantly higher than that in the four-screw group (69.2% vs. 42.1%, P=0.022) at six months postoperatively. No significant difference was found in the fusion rates at 3 and 12 months postoperatively between groups. Overall, PROMs significantly improved after surgery in both groups and did not differ significantly between groups at any follow-up time point. The prevalence of complications was not significantly different between groups.
Conclusions: Two-screw internal fixation can achieve osseous fusion faster than four-screw internal fixation in ACDF. Two-screw internal fixation seems to achieve the same PROMs and safety as four-screw internal fixation.
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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