Surgical Strategy and Clinical Efficacy Analysis of Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

Abstract

Background: There are relatively few studies on the treatment of symptomatic adjacent segment disease(ASD) after anterior cervical discectomy and fusion(ACDF). The purpose of this study to compare the clinical efficacy of zero-profile(zero-p) intervertebral fusion and titanium plate combined with cage fusion for treating ASD after ACDF. Methods: Retrospective analysis was performed on patients who underwent ACDF and readmission due to concurrent symptomatic ASD from October 2014 to June 2019. Among them, 12 cases underwent anterior cervical decompression with zero-p intervertebral fusion (zero-p group), and 14 cases underwent anterior cervical decompression with titanium plate combined with cage fusion (titanium plate group). Operative time, intraoperative blood loss, postoperative Japanese 0rthopaedic Association (JOA) score, visual analogue scale (VAS) scores, neck disability index (NDI), dysphagia Bazaz grade, bone graft fusion Eck grade, C2-C7 Cobb Angle, and related complications were compared between the two groups. Results: The intraoperative blood loss difference between the two groups was not statistically significant (P>0.05). The operation time of the zero-p group was shorter than that of the titanium plate group, with significant differences(P<0.05). The Bazaz classification of dysphagia in the zero-p group was superior to the titanium plate group 1 month after the operation, and the difference was statistically significant (P<0.05); However, there was no statistically significant difference between the two groups in the Bazaz classification of dysphagia and the bone graft fusion Eck grade at the last follow-up (P>0.05). At the last follow-up, the JOA score, VAS score, NDI index, C2-C7 Cobb Angle were significantly different between the zero-P group and the titanium plate group (P<0.05). However, no significant difference was found between the two groups (P>0.05). During the follow-up period, all the patients did not have a rupture of the settler screw and esophageal injury and other related diseases.Conclusions: Both methods can achieve good clinical efficacy in the treatment of symptomatic ASD, and can restore and maintain the physiological curvature of the cervical spine to a certain extent. However, the advantages of zero-p intervertebral fusion including shorter operation time, reducing soft tissue injury, and less postoperative dysphagia.

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

“…A search of bibliographic references yielded one additional study that met the selection criteria. As a result, 5 studies in total were included in the meta-analysis 27-31 (Figure 1). The characteristics of the included studies are summarized in Table 1.

Figure 1.Flow diagram of the search strategy and study selection as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

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“…A search of bibliographic references yielded one additional study that met the selection criteria. As a result, 5 studies in total were included in the meta-analysis 27 - 31 ( Figure 1 ). The characteristics of the included studies are summarized in Table 1 .…”

“…Three studies 29 - 31 reported C2-C7 Cobb angle changes and two studies 30 , 31 reported disc height index (DHI). At the final follow-up, compared to the baseline, the APC group showed significant improvement in C2-C7 Cobb angle [MD = 6.14, 95%CI = 3.80 - 8.48, P < .05], and DHI [MD = 1.69, 95%CI = 1.24 - 2.14, P < .05].…”

“…There was no significant difference in the radiological parameters when comparing APC vs SAAS in terms of C2-7 Cobb angle and DHI ( Figure 5 ). Two studies 28 , 29 reported fusion rate, with no difference in the fusion rate between groups [SDM = .23, 95%CI = −. 240 - .…”

“…Chen et al 53 reviewed 63 patients who underwent ACDF with SAAS for ASDis and found a 2-year fusion rate of 95.2%. In our review, only two studies 28,29 reported the fusion rate. Ghandi et al found that SAAS and APC fusion rates in treating ASDis were 82.35% and 68.97%, respectively.…”