Zero-Profile Versus Cage and Plate in Anterior Cervical Discectomy and Fusion with a Minimum 2 Years of Follow-Up: A Meta-Analysis

Sun, Zhicheng; Liu, Zheng; Wen-kai, HU; Yang, Yan; Xiao, Xiao; Wang, Xiyang

doi:10.1016/j.wneu.2018.08.128

Cited by 40 publications

(40 citation statements)

References 30 publications

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“…This design has greater advantages in decreasing incidence of postoperative dysphagia and ASD complications. As demonstrated in several clinical studies, the Zero-P group had a significantly reduced incidence of ASD compared with the PCC group [61][62][63][64][65][66][67]. Our kinematics simulation study showed a lower hypermobility in adjacent segments in the Zero-P fusion model than that in the standard PCC fusion model (Fig.…”

Section: Discussionsupporting

confidence: 68%

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Jin

Liang³

et al. 2020

BMC Surg

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Background: The development of adjacent segment degeneration (ASD) following ACDF is well established. There is no analytical study related to effects of plate profile on the biomechanics of the adjacent-level after ACDF. This study aimed to test the effects of plate profile on the adjacent-level biomechanics after single-level anterior cervical discectomy and fusion (ACDF). Methods: A three-dimensional finite element model (FEM) of an intact C2-T1 segment was built and validated. From this intact model, two instrumentation models were constructed with the anchored zero-profile spacer or the standard plate-interbody spacer after a C5-C6 corpectomy and fusion. Motion patterns, the stresses in the disc, the endplate, and the facet joint at the levels cephalad and caudal to the fusion were assessed. Results: Compared with the normal condition, the biomechanical responses in the adjacent levels were increased after fusion. Relative to the intact model, the average increase of range of motion (ROM) and stresses in the endplate, the disc, and the facet of the zero-profile spacer fusion model were slightly lower than that of the standard plate-interbody spacer fusion model. The kinematics ROM and stress variations above fusion segment were larger than that below. The biomechanical features of the adjacent segment after fusion were most affected during extension. Conclusions: The FE analysis indicated that plate profile may have an impact on the biomechanics of the adjacentlevel after a single-level ACDF. The impact may be long-term and cumulative. The current findings may help explain the decreasing incidence of ASD complications in the patients using zero-profile spacer compared with the patients using cage and plate construct.

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Section: Discussionsupporting

confidence: 68%

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Jin

Liang³

et al. 2020

BMC Surg

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“…Numerous studies have found no differences in GSP development when comparing the effects of implanted Zero-P ® cage and cage fixed by the conventional cervical plate 3,14,16,17 . Son et al however refer a more significant global lordotisation after the implantation of the anchored cage in comparison to a cage fixed by the conventional plate 18 . CS had no significant impact on the clinical outcome after ACDF 19,20 .…”

Section: Discussionmentioning

confidence: 96%

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

Opšenák¹,

Hanko²,

Snopko³

et al. 2021

BIOMED PAP

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Background. The aim of this study was to verify the relationship between changes in the segmental sagittal profile (SSP) and changes in the global sagittal profile (GSP) after anterior cervical discectomy with anchored cage implantation (ACDF). Study design. Prospective study with 2-year follow-up. Methods. This study includes 104 patients after 1-level or 2-level ACDF operated between the May 2013 and March 2016. SSP was evaluated by Cobb angle measurement of operated motion segment (CobbS) and GSP was evaluated by Cobb angle measurement in C2-C7 segments (CobbG). Both SSP and GSP were measured pre-and postoperatively within a 24 months follow-up period. The influence of factors such as age, gender, number of treated segments and osteoporosis was evaluated using t-tests. The correlation between SSP and GSP changes was assessed by Pearson's correlation coefficient. Results. In the early postoperative period after 1-level ACDF, there was a significantly greater increase in CobbS compared to that of the 2-level ACDF (P=0.0149). Male patients experienced a significant decrease of CobbG during the first 6 months after surgery as well as patients with osteoporosis within 12 months after ACDF. After ACDF the SSP change weakly correlated with the GSP change. Conclusion. SSP change after 1-or 2-level ACDF correlates mostly weakly with GSP change. Male gender and osteoporosis were identified as risk factors for global lordotisation following ACDF.

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“…48 Previously published meta-analyses have found a statistically significant increase of dysphagia in patients who underwent ACDF with anterior plate compared with standalone ACDF. 35,49 A large meta-analysis also showed that ACDF with anterior plating has higher rates of developing dysphagia when compared with CDA. 12 In this metaanalysis, which included a total of 527 patients in comparative studies measuring dysphagia, patients undergoing CDA had a lower risk ratio of developing dysphagia when compared with stand-alone ACDF but without statistical significance (P ¼ .2368).…”

Section: Summary Of Evidencementioning

confidence: 99%

“…55,56 When measuring outcomes of stand-alone ACDF compared with traditional ACDF, previous studies have validated the use of stand-alone ACDF techniques when assessing NDI, VAS, and JOA scores and rates of successful fusion. 35,40,49,57 Of note, stand-alone devices were found to be an effective treatment option for patients with up to 3-and 4-level spine disease as well. 57,58 However, one potential disadvantage of the standalone technique is an increased incidence of subsidence in the stand-alone device fusions when compared with traditional ACDF that is described in literature.…”

Section: Summary Of Evidencementioning

confidence: 99%

Outcomes After Cervical Disc Arthroplasty Versus Stand-Alone Anterior Cervical Discectomy and Fusion: A Meta-Analysis

Gendreau

Kim

Prins

et al. 2019

Global Spine Journal

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Study Design: Systemic review and meta-analysis. Objectives: To review and compare surgical outcomes for patients undergoing stand-alone anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for the treatment of cervical spine disease. Methods: A systematic search was performed on PubMed, Medline, and the Cochrane Library. Comparative trials measuring outcomes of patients undergoing CDA and stand-alone ACDF for degenerative spine disease in the last 10 years were selected for inclusion. After data extraction and quality assessment, statistical analysis was performed with R software metafor package. The random-effects model was used if there was heterogeneity between studies; otherwise, the fixed-effects model was used. Results: In total, 12 studies including 859 patients were selected for inclusion in the meta-analysis. Patients undergoing stand-alone ACDF had a statistically significant increase in postoperative segmental angles (mean difference 0.85° [95% confidence interval = 0.35° to 1.35°], P = .0008). Patients undergoing CDA had a decreased rate of developing adjacent segmental degeneration (risk ratio = 0.56 [95% confidence interval = −0.06 to 1.18], P = .0745). Neck Disability Index, Japanese Orthopedic Association score, Visual Analogue Scale of the arm and neck, as well as postoperative cervical angles were similar between the 2 treatments. Conclusions: When compared with CDA, stand-alone ACDF offers similar clinical outcomes for patients and leads to increased postoperative segmental angles. We encourage further blinded randomized trials to compare rates of adjacent segmental degeneration and other postoperative outcomes between these 2 treatments options.

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Zero-Profile Versus Cage and Plate in Anterior Cervical Discectomy and Fusion with a Minimum 2 Years of Follow-Up: A Meta-Analysis

Cited by 40 publications

References 30 publications

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

Outcomes After Cervical Disc Arthroplasty Versus Stand-Alone Anterior Cervical Discectomy and Fusion: A Meta-Analysis

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