Anterior Cervical Discectomy and Fusion (ACDF): Comparison Between Zero Profile Implants and Anterior Cervical Plate and Spacer

Abstract

Introduction: Interposition grafts combined with anterior plating currently remain the gold standard for anterior cervical discectomy and fusion. The use of anterior plates increases fusion rates but may be associated with higher rates of postoperative dysphagia. The aim of the current study was to determine the clinical and radiological outcomes following anterior cervical discectomy and fusion (ACDF) using zero-profile anchored spacers versus standard interposition grafts with anterior plating.Methods: This was a retrospective case series. A total of 53 male and 51 female consecutive patients (164 total operated levels) who underwent ACDF between 2007 and 2011 were included. The mean clinical follow-up was 15.7 ± 1.2 (SEM) months for patients with zero-profile implants and 14.8 ± 2.1 months for patients with conventional ACDF with anterior plating. Patient demographics, operative details, clinical outcomes, complications, and radiographic imaging were reviewed. Dysphagia was determined using the Bazaz criteria.Results: Clinical outcome scores improved in both groups as measured by the modified Japanese Orthopedic Association and Nurick scores. Zero-profile constructs gave rise to significantly less prevertebral soft tissue swelling compared to constructs with anterior plates postoperatively (15.74 ± 0.52 as compared to 20.48 ± 0.85 mm, p < 0.001) and at the latest follow-up (10.88 ± 0.39 mm vs. 13.72 ± 0.67 mm, p < 0.001). There was a significant difference in the incidence of dysphagia at the latest follow-up (1.5% vs. 20%, p=0.001, zero-profile vs. anterior plate, respectively).Conclusion: Zero-profile implants lead to functional outcomes similar to standard anterior plate constructs. Avoiding the use of an anterior locking plate may decrease the risk of persistent postoperative dysphagia.

A Comparison Of The Bridge-Type Roi-c Interbody Fusion Cage System And Titanium Mesh Graft With Titanium Plate Fixation In 2-Level Anterior Cervical Discectomy And Fusion With Plating And Cage System: A Retrospective Study

“…A large number of clinical studies have shown that after plate xation is xed, the plate will protrude from the surface of cervical body, which cause slight compression on the esophagus [17,18] . Some scholars reported that the use of thinner plate xation will reduce the incidence of dysphagia [19] . Previous studies have also shown that the use of zero-pro le anchored spacer can signi cantly reduce the incidence of dysphagia.…”

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

“…ACDF improved the modified JOA scores and Nurick grades postoperatively [13,14]. Moreover, several studies reported that this technique provided higher postoperative JOA scores [9,[15][16][17][18][19].…”

“…The primary complications after ACDF with anterior plate are chronic dysphagia and prevertebral soft tissue swelling [13,22]. The mechanism for these complications are still not well understood; however, it is proposed that retraction during surgery, direct pressure to the esophagus by the anterior plate, and irritation of the surrounding soft tissues may contribute to the complications occurring post ACDF with anterior plate [13].…”

“…The mechanism for these complications are still not well understood; however, it is proposed that retraction during surgery, direct pressure to the esophagus by the anterior plate, and irritation of the surrounding soft tissues may contribute to the complications occurring post ACDF with anterior plate [13]. Alimi et al [13] demonstrated that the zero profile implant was more superior to the anterior plate in reducing the dysphagia score. Fengbin et al [23] conducted a randomized prospective study to identify the approach that should be used to reduce dysphagia postoperatively.…”

“…It utilizes an integrated and low profile plate design to avoid implant-to-soft tissue impact [22]. Alimi et al [13] reported that the zero profile implant exhibited lesser postoperative soft tissue thickness than the anterior plate. This indicates that the zero profile implant may reduce the irritation of the surrounding soft tissues compared with the anterior plate.…”