Can Zero-Profile Cage Maintain the Cervical Curvature Similar to Plate-Cage Construct for Single-Level Anterior Cervical Diskectomy and Fusion?

Li, Tao; Yang, Jun-Song; Wang, Xiang-Fu; Meng, Chunyang; Wei, Jiacheng; Wang, Ye-Xin; Zou, Peng; Chen, Hao; Liu, Tuan-Jiang; Liu, Peng; Hao, Dingjun; Chu, Lei

doi:10.1016/j.wneu.2019.11.153

Cited by 20 publications

(37 citation statements)

References 19 publications

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“…Postoperative cervical alignment is affected by many factors, and the improvement and maintaining of postoperative cervical sagittal alignment proved to be related to satisfactory clinical outcomes [ 5 , 10 , 26 ]. Intraoperative resection of anterior osteophytes with endplate resection can impact postoperative cervical sagittal alignment [ 11 , 27 , 28 ]. The number of surgical levels and pattern of implants can influence the compensatory ability of the remaining nonfused levels [ 11 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

Wang

Huang

et al. 2022

BMC Musculoskelet Disord

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Purpose To investigate the relationship between the preoperative paraspinal Goutalier grade of fatty infiltration and postoperative cervical sagittal alignment in patients undergoing anterior cervical discectomy and fusion (ACDF). Methods A total of 101 patients who underwent single-level ACDF with the Zero-profile implant system between March 2011 and April 2020 were included in this study. Cervical sagittal alignment parameters, including the C2-C7 Cobb angle, functional spinal unit (FSU) angle, cervical sagittal vertical axis (SVA), and T1 slope (T1S), were assessed. Preoperative magnetic resonance images were used to classify patients according to Goutalier grade. Clinical outcomes including Neck Disability Index (NDI) scores, Japanese Orthepaedic Association (JOA) scores and Visual Analogue Scale (VAS) scores were collected and analyzed. Results According to the Goutalier grade, 33 patients were classified as Goutalier 0–1 (Group A), 44 were classified as Goutalier 1.5–2 (Group B), and 24 were classified as Goutalier 2.5–4.0 (Group C). The mean age among the three groups showed significant differences (P = 0.007). At the last follow-up, the C2-C7 Cobb angle, FSU angle, and T1S improved after the surgery among the groups. Although there were varying degrees of loss of curvature among the different groups during the follow-up period, the postoperative cervical sagittal alignment parameters demonstrated no statistical differences among the three groups (P > 0.05). In addition, patients in all groups experienced significant relief of their symptoms, and the clinical scores were comparable among the groups (P > 0.05). Conclusion The complex nature of anterior cervical surgery requires surgical attention both in decompression and sagittal alignment. Our study demonstrates satisfactory postoperative cervical sagittal alignment of patients despite different grades of fatty infiltration of the multifidus muscle following single-level ACDF. Based on our results, the improvement and maintenance of cervical sagittal alignment after ACDF remains a complex problem that spine surgeons should consider before surgery.

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Section: Discussionmentioning

confidence: 99%

“…Postoperative cervical sagittal alignment is affected by many factors, such as the type of implant system, distraction degree, intraoperative procedure, and paraspinal muscle status [ 11 – 14 ]. Theoretically, to maintain a forward gaze position, the posterior extensor muscles of the neck need to be contracted [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

Wang

Huang

et al. 2022

BMC Musculoskelet Disord

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“…The possible reason for these results may be due to the trilateral mini plate designed to restrict cage subsidence and maintain segmental curvature. Another possible reason may be attributed to the screw placement differences in two devices, which they go through the cortical bone in a more parallel angle in Carmen implant, while the screws go through the cage first and then go through the endplate to the cancellous bone in zero profile device, as mentioned in previous studies [ 16 , 21 ].…”

Section: Discussionmentioning

confidence: 97%

“…Later on, various types of implants and devices have been developed to assist intervertebral fusion. Of all devices, the plate and cage system can provide solid stability and improve cervical sagittal alignment [ 16 ], and is widely used till now due to such advantages. However, this system has been reported to have higher risks of having complications like dysphagia and adjacent segment degeneration (ASD), which were not negligible.…”

Section: Discussionmentioning

confidence: 99%

“…Although Zero-P system has been proved to have advantages over traditional plate and cage system in postoperative complications, and has comparable clinical outcomes to traditional plate and cage system as provided by previous researches [ 7 – 9 , 11 , 18 ], it is less efficient in dealing with cervical alignment anomalies. Recent reports have demonstrated that compared with titanium plate and cage system, zero profile system failed to maintain C2-7 Cobb angle, segmental Cobb angle and adjacent vertebral height in longer follow-ups [ 16 ]. While other reports showed that multiple Zero-P fixation failed to maintain cervical lordosis when compared to plate and cage system [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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Application of a new integrated low-profile anterior plate and cage system in single-level cervical spondylosis: a preliminary retrospective study

Wei

Dong

et al. 2022

J Orthop Surg Res

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Background Although ACDF has been widely used in treating cervical spondylosis and related diseases, the complications along with this anterior surgical technique have hindered its application and affected the postoperative outcome of the patients. Here, we investigated the clinical and radiological outcomes of a new integrated low-profile anterior plate and cage system for anterior cervical discectomy and fusion (ACDF) in treating cervical spondylosis. Methods A total of 96 cervical spondylosis patients who underwent single-level ACDF between 2018 to 2020 in our institute were enrolled. There were 28 patients using the new implants and 68 patients using the zero-profile (Zero-P) implants. The Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) were used to evaluate the clinical outcomes. The cervical and segmental Cobb angle and range of motion (ROM) were used to assessed the radiological outcomes. Incidence of complications were also recorded. All data were recorded at pre-operation, 6-month and 12-month post-operation. Results All patients were followed-up for at least 1-year, the mean follow-up time was over one year. The fusion rate was similar in the two groups. There was no significant difference in the postoperative JOA score recovery rate, postoperative VAS score of neck and arm pain, postoperative ROM, and incidence of complications between two groups (P > 0.05). However, postoperative cervical and segmental Cobb angle were better maintained in the new low-profile implant group compared to Zero-P group. Conclusions The clinical outcomes of the new low-profile implant were satisfactory and comparable to that of zero-profile system. It may have advantages in improving and maintaining the cervical lordosis, and can be an alternative device for single-level cervical spondylosis treated with ACDF.

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Comparison of the Postoperative Motion Stabilization Between Anterior Cervical Decompression and Fusion with a Zero-Profile Implant System and a Plate-Cage Construct

Abudouaini

Líu

et al. 2022

World Neurosurgery

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Can Zero-Profile Cage Maintain the Cervical Curvature Similar to Plate-Cage Construct for Single-Level Anterior Cervical Diskectomy and Fusion?

Cited by 20 publications

References 19 publications

Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

Fatty infiltration in cervical extensor muscle: is there a relationship with cervical sagittal alignment after anterior cervical discectomy and fusion?

Application of a new integrated low-profile anterior plate and cage system in single-level cervical spondylosis: a preliminary retrospective study

Comparison of the Postoperative Motion Stabilization Between Anterior Cervical Decompression and Fusion with a Zero-Profile Implant System and a Plate-Cage Construct

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