Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2–19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0–10) to 0 (range 0–8; p &lt; 0.001). The arm VAS score improved from a median of 2 (range 0–10) to 0 (range 0–7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0–3) immediately postoperatively to 0 (range 0–2; p &lt; 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p &lt; 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.</jats:p></jats:sec>

Comparison among perfect-C®, zero-P®, and plates with a cage in single-level cervical degenerative disc disease

“…ACDF is the most common method in degenerative disc disease of the cervical spine when conservative therapy has failed [12]. Many anterior cervical instruments have been introduced due to the continuous development of surgical methods and devices.…”

“…Many anterior cervical instruments have been introduced due to the continuous development of surgical methods and devices. The composition of an anterior cervical plate and an interbody cage in ACDF is possible to increase fusion rates compared with the ACDF without anterior plates [12,14]. Numerous articles have reported the effective use of placing plates to prevent pseudoarthrosis, subsidence, and local kyphosis [15].…”

“…3b) [11]. Subsidence was defined by calculating the distance from the superior endplate of the upper vertebral body to the inferior endplate of the lower vertebral body at the level of the operation [12]. Subsidence calculations were performed from the anterior and posterior borders of the vertebral bodies [12].…”

“…Subsidence was defined by calculating the distance from the superior endplate of the upper vertebral body to the inferior endplate of the lower vertebral body at the level of the operation [12]. Subsidence calculations were performed from the anterior and posterior borders of the vertebral bodies [12]. Subsidence was explained as a decline in the height of the surgical segment greater than 3 mm between the images obtained immediately after the operation and those obtained at the last follow-up.…”

“…Subsidence was explained as a decline in the height of the surgical segment greater than 3 mm between the images obtained immediately after the operation and those obtained at the last follow-up. The prevertebral soft-tissue thickness was decided by evaluating the thickness of soft tissue from the anterior side of the C3-7 vertebrae to the posterior side of the trachea [12]. The cephalad plate-todisc distance (PDD) and caudal plate-to-disc distance (PDD) were also measured, and the PDD/ABH (PDD to anterior body height) ratio was then determined (Fig.…”