Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials

Zhao, Ye; Yang, Sidong; Huo, Yachong; Li, Zhaohui; Yang, Dalong; Ding, Wenyuan

doi:10.1007/s00586-020-06561-x

Cited by 21 publications

(14 citation statements)

References 58 publications

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“…ACDF is a procedure frequently indicated in the surgical management of cervical myelopathy or radiculopathy due to its demonstrated clinical outcomes ( Zhao et al, 2020 ). A solid intervertebral fusion plays a key role in achieving satisfactory long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Shen

Yang

Líu

et al. 2022

Front. Bioeng. Biotechnol.

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Introduction: Anterior cervical discectomy and fusion (ACDF) is a widely accepted surgical procedure in the treatment of cervical radiculopathy and myelopathy. A solid interbody fusion is of critical significance in achieving satisfactory outcomes after ACDF. However, the current radiographic techniques to determine the degree of fusion are inaccurate and radiative. Several animal experiments suggested that the mechanical load on the spinal instrumentation could reflect the fusion process and evaluated the stability of implant. This study aims to investigate the biomechanical changes during the fusion process and explore the feasibility of reflecting the fusion status after ACDF through the load changes borne by the interbody fusion cage.Methods: The computed tomography (CT) scans preoperatively, immediately after surgery, at 3 months, and 6 months follow-up of patients who underwent ACDF at C5/6 were used to construct the C2–C7 finite element (FE) models representing different courses of fusion stages. A 75-N follower load with 1.0-Nm moments was applied to the top of C2 vertebra in the models to simulate flexion, extension, lateral bending, and axial rotation with the C7 vertebra fixed. The Von Mises stress at the surfaces of instrumentation and the adjacent intervertebral disc and force at the facet joints were analyzed.Results: The facet contact force at C5/6 suggested a significantly stepwise reduction as the fusion proceeded while the intradiscal pressure and facet contact force of adjacent levels changed slightly. The stress on the surfaces of titanium plate and screws significantly decreased at 3 and 6 months follow-up. A markedly changed stress distribution in extension among three models was noted in different fusion stages. After solid fusion is achieved, the stress was more uniformly distributed interbody fusion in all loading conditions.Conclusions: Through a follow-up study of 6 months, the stress on the surfaces of cervical instrumentation remarkably decreased in all loading conditions. After solid intervertebral fusion formed, the stress distributions on the surfaces of interbody cage and screws were more uniform. The stress distribution in extension altered significantly in different fusion status. Future studies are needed to develop the interbody fusion device with wireless sensors to achieve longitudinal real-time monitoring of the stress distribution during the course of fusion.

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Section: Discussionmentioning

confidence: 99%

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Shen

Yang

Líu

et al. 2022

Front. Bioeng. Biotechnol.

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“…A study by Yang et al [7] in 2019 compared ACP and SAC in terms of JOA score, NDI score, fusion rate, dysphagia rate, and adjacent segment degeneration. Another meta-analysis by Zhao et al [8] in 2020 described clinical and radiological outcomes of the two procedures, stating that SAC is superior to ACP in terms of lower complication rates and comparable clinical outcomes. However, they only included 1-4 articles in each forest plot, causing the possibility of analysis bias [8].…”

Section: Discussionmentioning

confidence: 99%

“…Another meta-analysis by Zhao et al [8] in 2020 described clinical and radiological outcomes of the two procedures, stating that SAC is superior to ACP in terms of lower complication rates and comparable clinical outcomes. However, they only included 1-4 articles in each forest plot, causing the possibility of analysis bias [8]. In studies by Yin et al [3] in 2016 and Nambiar et al [9] in 2017, a detailed analysis was performed for several outcomes.…”

Section: Discussionmentioning

confidence: 99%

Thorough Comparative Analysis of Stand-Alone Cage and Anterior Cervical Plate for Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Disease: A Systematic Review and Meta-analysis

et al. 2022

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In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.

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“…Some scholars conducted experimental research on the relevant mechanics of the anterior cervical plate screw internal fixation system [4][5][6]. Zhao et al [7] believed that the locking independent fusion cage was more effective than the anterior plate internal fixator in the anterior cervical discectomy and fusion. Feng et al [8] compared the mechanical properties of the cross nails and parallel nails in the anterior cervical plate screw system.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children

Zhou

et al. 2022

Computational and Mathematical Methods in Medicine

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Background. Spinal injury in children usually occurs in the cervical spine region. Anterior fixation of the lower cervical spine has been applied in treating pediatric cervical spine injury and disease due to its stable and firm mechanical properties. This study performed finite element analysis and comparison of four different anterior cervical internal fixation systems for children to explore more standard methods of anterior cervical internal fixation in children and seek more effective and safe treatment for children’s cervical spine diseases. Methods. A finite element model of 6-year-old children with lower cervical spine C4/5 discectomy was established, and the self-designed lower cervical spine anterior locking internal fixation system ACBLP and the children’s anterior cervical internal fixation system ACOP, ACVLP, and ACSLP plate screws were fixed and loaded on the model. 27.42 N·m torque load was applied to each internal fixation model under six working conditions of anteflexion, backward flexion, left flexion, right flexion, left rotation, and right rotation, to simulate the movement of the cervical spine. The activity and stress distribution cloud diagram of each finite element model was obtained to explore the optimal method of anterior cervical fixation in children. Results. In the four internal fixation models of ACOP, ACVLP, ACSLP, and ACBLP, the mobility of the C4/5 segment showed a decreasing relationship, and the mobility of adjacent segments increased significantly. In the Mises stress cloud diagram of the cervical spine of the four models, the vertebral body and accessories of the ACBLP model born the least stress, followed by ACSLP. The steel plate and screws in the ACVLP internal fixation model were the most stressed. The stress of the internal fixation system (plate/screw) in all models increased in the order of ACBLP, ACSLP, ACVLP, and ACOP. Conclusions. ACBLP internal fixation system had obvious advantages in anterior internal fixation of the lower cervical spine in children, C4/5 had the smallest degree of movement, relative displacement was minimal, and the stress on the centrum and pedicle was the least, while the stress on the plate screw was relatively the smallest.

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Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials

Cited by 21 publications

References 58 publications

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Biomechanical Evaluation of Intervertebral Fusion Process After Anterior Cervical Discectomy and Fusion: A Finite Element Study

Thorough Comparative Analysis of Stand-Alone Cage and Anterior Cervical Plate for Anterior Cervical Discectomy and Fusion in the Treatment of Cervical Degenerative Disease: A Systematic Review and Meta-analysis

Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children

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