Anterior Cervical Discectomy and Fusion Using Zero-P System for Treatment of Cervical Spondylosis: A Meta-Analysis

Abstract

Objective. The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis. Methods. Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups. Results. A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = −0.23, CI (−1.38, 95% 0.92), P = 0.69], postoperative cervical curvature [WMD = −0.38, CI (−1.77, 95% 1.01), P = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P = 0.38], preoperative DHI [WMD = −0.04, CI (−0.14, 95% 0.22), P = 0.65], and postoperative DHI [WMD = 0.06, CI (−0.22, 95% 0.34), P = 0.675] were not significantly different between the two groups. Conclusion. It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

“…Five patients (12.8%) who underwent the anterior approach had transient dysphagia one week postoperatively but recovered after subsequent treatment. Based on the incidence of 904 patients in the meta-analysis of Guo et al, our incidence was similar to the 13.97% of zero-p and lower than the 26.01% of plate-cage [ 10 ]. This suggests that Low-P can achieve a similar effect to zero-p in reducing the incidence of postoperative dysphagia.…”

“…However, a higher number of surgical levels, high-profile internal fixation, and prolonged muscle traction may lead to a higher rate of cage subsidence and nonunion, as well as a higher incidence of dysphagia [ 4 , 5 , 7 ]. Zero-profile cages have been trialed in MDCM, which help reduce the risk of developing dysphagia, but higher-risk cage subsidence rates and cervical alignment problems must be considered [ 8 , 9 , 10 ]. Posterior cervical laminectomy and instrumented fusion (PCLF) can achieve indirect decompression by causing the spinal cord to drift posteriorly and is mostly used in patients with MDCM [ 1 , 3 , 11 ], but the widely used traditional lateral mass screw fixation is not very stable and does not provide satisfactory correction of kyphosis [ 12 , 13 , 14 ].…”

Stand-Alone Anchored Spacer vs Anterior Plate Construct in the Management of Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Systematic Review and Meta-Analysis of Comparative Studies

“…Unsurprisingly, as both techniques rely on cage or graft insertion, our meta-analysis found no difference between SAAS and APC in restoring disc height. 50 It has been reported that primary ACDF showed a fusion rate of 92-95% in treating primary cervical pathologies such as spondylosis or trauma. 51,52 Guo et al, 50 on the other hand, found lower but comparable fusion rates between APC and SAAS groups, with rates of (173/199 = 86.9%) and (156/184 = 84.8%), respectively.…”

“…50 It has been reported that primary ACDF showed a fusion rate of 92-95% in treating primary cervical pathologies such as spondylosis or trauma. 51,52 Guo et al, 50 on the other hand, found lower but comparable fusion rates between APC and SAAS groups, with rates of (173/199 = 86.9%) and (156/184 = 84.8%), respectively. Chen et al 53 reviewed 63 patients who underwent ACDF with SAAS for ASDis and found a 2-year fusion rate of 95.2%.…”

Patient-specific numerical investigation of the correction of cervical kyphotic deformity based on a retrospective clinical case

“…However, Park et al (2019) conducted a retrospective cohort study on discectomy and found that multi-level fusion was significantly associated with the increased risk of screw failure (p < 0.01). Screw loosening and plate migration in the anterior cervical discectomy fusion (ACDF) is not rare (Ning et al, 2008;Guo et al, 2021), even though hardware failure attributed to ACDF was demonstrated only 0.1%-0.9% in the United States (Epstein, 2019). Many clinical case reports revealed that screw loosening and anterior cervical plate migration happened in ACDF (Azadarmaki and Soliman, 2014;Nathani et al, 2015;Wójtowicz et al, 2015;Fryer et al, 2019;Ansari et al, 2020).…”