Zero-profile implant versus conventional cage-plate implant in anterior cervical discectomy and fusion for the treatment of degenerative cervical spondylosis: a meta-analysis

Shao, Haiyu; Chen, Jinping; Ru, Bin; Yan, F.; Zhang, Jun; Xu, Shaonan; Huang, Yanlei

doi:10.1186/s13018-015-0290-9

Cited by 35 publications

(41 citation statements)

References 26 publications

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“…Evidence supports utilization of cervical standalone implants, either along the whole construct or above C4, to decrease the chances of dysphagia. 3,17 Further, a prolonged anterior approach lasting more than 3 hours, particularly with longus coli muscle retraction, is likely responsible for higher prevertebral soft-tissue swelling and resultant higher rates of dysphagia and prolonged intubation. Use of narrow blades and intermittent longus retraction may help obviate some of the complications.…”

Section: Discussionmentioning

confidence: 99%

Perioperative complications with multilevel anterior and posterior cervical decompression and fusion

Wewel

Brahimaj

Kasliwal

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVECervical spondylotic myelopathy (CSM) is a progressive degenerative pathology that frequently affects older individuals and causes spinal cord compression with symptoms of neck pain, radiculopathy, and weakness. Anterior decompression and fusion is the primary intervention to prevent neurological deterioration; however, in severe cases, circumferential decompression and fusion is necessary. Published data regarding perioperative morbidity associated with these complex operations are scarce. In this study, the authors sought to add to this important body of literature by documenting a large single-surgeon experience of single-session circumferential cervical decompression and fusion.METHODSA retrospective analysis was performed to identify intended single-stage anterior-posterior or posterior-anterior-posterior cervical spine decompression and fusion surgeries performed by the primary surgeon (V.C.T.) at Rush University Medical Center between 2009 and 2016. Cases in which true anterior-posterior cervical decompression and fusion was not performed (i.e., those involving anterior-only, posterior-only, or delayed circumferential fusion) were excluded from analysis. Data including standard patient demographic information, comorbidities, previous surgeries, and intraoperative course, along with postoperative outcomes and complications, were collected and analyzed. Perioperative morbidity was recorded during the 90 days following surgery.RESULTSSeventy-two patients (29 male and 43 female, mean age 57.6 years) were included in the study. Fourteen patients (19.4%) were active smokers, and 56.9% had hypertension, the most common comorbidity. The most common clinical presentation was neck pain in 57 patients (79.2%). Twenty-three patients (31.9%) had myelopathy, and 32 patients (44.4%) had undergone prior cervical spine surgery. Average blood loss was 613 ml. Injury to the vertebral artery was encountered in 1 patient (1.4%). Recurrent laryngeal nerve palsy was observed in 2 patients (2.8%). Two patients (2.8%) had transient unilateral hand grip weakness. There were no permanent neurological deficits. Dysphagia was encountered in 45 patients (62.5%) postoperatively, with 23 (32%) requiring nasogastric parenteral nutrition and 9 (12.5%) patients ultimately undergoing percutaneous endoscopic gastrostomy (PEG) placement. Nine of the 72 patients required a tracheostomy. The incidence of pneumonia was 6.9% (5 patients) overall, and 2 of these patients were in the tracheostomy group. Superficial wound infections occurred in 4 patients (5.6%). Perioperative death occurred in 1 patient. Reoperation was necessary in 10 patients (13.9%). Major perioperative complications (permanent neurological deficit, vascular injury, tracheostomy, PEG tube, stroke, or death) occurred in 30.6% of patients. The risk of minor perioperative complications (temporary deficit, dysphagia, deep vein thrombosis, pulmonary embolism, urinary tract infection, pneumonia, or wound infection) was 80.6%.CONCLUSIONSSingle-session anterior-posterior cervical decompression and fusion is an inherently morbid operation required in select patients with cervical spondylotic myelopathy. In this large single-surgeon series, there was a major perioperative complication risk of 30.6% and minor perioperative complication risk of 80.6%. This overall elevated risk for postoperative complications must be carefully considered and discussed with the patient preoperatively. In some situations, shared decision making may lead to the conclusion that a procedure of lesser magnitude may be more appropriate.

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Section: Discussionmentioning

confidence: 99%

Perioperative complications with multilevel anterior and posterior cervical decompression and fusion

Wewel

Brahimaj

Kasliwal

et al. 2020

Journal of Neurosurgery: Spine

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“…Stand-alone cages afford comparable mechanical stability and efficacy compared to anterior plating, but current literature is polarizing with regard to their complication incidence. 14 - 17 Additionally, no studies have directly compared cases performed utilizing a plate or stand-alone cage with respect to length of hospital stay or ability to send patients home the same day of surgery. 18 …”

Section: Introductionmentioning

confidence: 99%

A Matched Cohort Analysis Comparing Stand-Alone Cages and Anterior Cervical Plates Used for Anterior Cervical Discectomy and Fusion

Overley

Merrill

Leven

et al. 2017

Global Spine Journal

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Study Design:Retrospective cohort study.Objective:To compare perioperative characteristics of stand-alone cages and anterior cervical plates used for anterior cervical discectomy and fusion (ACDF).Methods:We reviewed 40 adult patients who received a stand-alone cage for elective ACDF and matched them with 40 patients who received an anterior cervical plate. We statistically compared operative time, length of stay, proportion of ambulatory cases, overall complications necessitating a trip to the ED, readmission, or reoperation related to index procedure.Results:There were 21 women and 19 men in the plate cohort with average ages of 53 years ± 12 and 20 women and 20 men in the stand-alone group with an average age of 52 years ± 11. With no statistical difference in total number, the plate group experienced 4 short-term (within 90 days of discharge) complications, including 3 patients who visited the emergency department for dysphagia and 1 who visited the emergency department for severe back pain, while the stand-alone group experienced 0 complications. There was no significant difference in operative time between the stand-alone group (75.35 min) and the plate group (81.35 min; P = .37). There was a significant difference between the proportion of ambulatory cases in the stand-alone group (25) and the plate group (6; P < .0001).Conclusion:Our results demonstrate that stand-alone cages have fewer complications compared to anterior plating, with a lower trend of incidence of postoperative dysphagia. Stand-alone cages may offer the advantage of sending patients home ambulatory after ACDF surgery.

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“…It has been shown to provide similar biomechanical stability to the use of a cage and anterior plating system [ 13 ]. The same conclusion was drawn from a study involving patients with degenerative pathology, and the Zero-P has been used in ACDF for the treatment of degenerative cervical disease [ 14 ]. However, these previous studies did not provide sufficient evidence on the efficiency or safety of Zero-P in traumatic cervical disc injury.…”

Section: Introductionmentioning

confidence: 59%

“…Additionally, Njoku et al [ 11 ] reported that the Zero-P had clinical outcomes and radiologic fusion rates comparable with the cage-plate system. Most studies have assessed the postoperative outcomes of ACDF using Zero-P in cases of degenerative cervical spondylosis, Zero-P has been accepted as a useful graft for ACDF in degenerative cervical disc disease [ 2 , 4 , 11 , 14 , 16 ]. Based on these previous studies, we used Zero-P as a graft for ACDF in cases of traumatic disc injury.…”

Section: Discussionmentioning

confidence: 99%

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

Kim

et al. 2018

J Korean Neurosurg Soc

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ObjectiveThe zero-profile implant (Zero-P) is accepted for use in anterior cervical fusion for the treatment of degenerative cervical disease. However, evidence pertaining to its efficiency and safety in traumatic cervical injury is largely insufficient. This study aimed to compare the overall outcomes of patients who underwent Zero-P for traumatic cervical disc injury. MethodsData from a total of 53 consecutive patients who underwent surgery for traumatic or degenerative cervical disc disease using the Zero-P were reviewed. Seventeen patients (group A) had traumatic cervical disc injury and the remaining 36 (group B) had degenerative cervical disc herniation. The fusion and subsidence rates and Cobb angle were measured retrospectively from plain radiographs. The patients’ clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score and Odom’s criteria. ResultsThe C2–7 Cobb and operative segmental angles increased by 3.45±7.61 and 2.94±4.59 in group A; and 2.46±7.31 and 2.88±5.49 in group B over 12 postoperative months, respectively. The subsidence and fusion rate was 35.0% and 95.0% in group A; and 36.6% and 95.1% in group B, respectively. None of the parameters differed significantly between groups. The clinical outcomes were similar in both groups in terms of increasing the JOA score and producing a grade higher than “good” using Odom’s criteria. ConclusionThe application of Zero-P in patients with traumatic cervical disc injury was found to be acceptable when compared with the clinical and radiological outcomes of degenerative cervical spondylosis.

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Zero-profile implant versus conventional cage-plate implant in anterior cervical discectomy and fusion for the treatment of degenerative cervical spondylosis: a meta-analysis

Cited by 35 publications

References 26 publications

Perioperative complications with multilevel anterior and posterior cervical decompression and fusion

Perioperative complications with multilevel anterior and posterior cervical decompression and fusion

A Matched Cohort Analysis Comparing Stand-Alone Cages and Anterior Cervical Plates Used for Anterior Cervical Discectomy and Fusion

Can the Zero-Profile Implant Be Used for Anterior Cervical Discectomy and Fusion in Traumatic Subaxial Disc Injury? A Preliminary, Retrospective Study

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