Use of zero-profile device for contiguous three-level anterior cervical discectomy and fusion: comparison with cage and plate construct

View More View Less
  • 1 Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
  • | 2 Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The aim of this study was to compare a traditional cervical cage with a zero-profile (ZP) fixation device in patients who underwent three-level anterior cervical decompression and fusion (ACDF) in terms of patient-reported outcomes (visual analog scale [VAS], Japanese Orthopaedic Association [JOA], and Neck Disability Index [NDI] scores), radiographic findings (sagittal alignment 2 years after surgery and likelihood of fusion), and complications.

METHODS

This study was a retrospective case series. Between January 2012 and December 2016, 58 patients with cervical spondylotic myelopathy (CSM) who required three-level ACDF procedures, as identified by spinal surgeons, were treated with three-level ACDF and an anterior cage-plate construct (ACPC) (n = 38) or a three-level stand-alone ZP device (n = 20). On the basis of patient choice, patients were divided into two groups (ACPC group and ZP group). All patients completed a minimum of 2 years of follow-up. Patient-reported outcome scores included VAS, JOA, and NDI scores. The radiographic findings included sagittal alignment and likelihood of fusion 2 years after surgery. Data related to patient-reported outcomes and sagittal alignment were collected preoperatively, postoperatively, and at the final follow-up. Intraoperative and postoperative complications were also documented and analyzed.

RESULTS

The clinical outcomes, including VAS, JOA, and NDI scores, showed improvement in both groups, and no significant difference was observed between the two groups. Sagittal alignment and height of the fused segments were restored in all patients. However, the authors found no differences between the ZP and ACPC groups, and the groups exhibited similar fusion rates. The authors found no differences in complications, including dysphagia, adjacent-segment degeneration, and postoperative hematoma, between the groups.

CONCLUSIONS

Use of ZP implants yielded satisfactory long-term clinical and radiological outcomes that were similar to those of the standard ACPC. Additionally, the rates of complications between the groups were not significantly different. Although the best surgical option for multilevel CSM remains controversial, the results of this work suggest that ACDF with the ZP device is feasible, safe, and effective, even for multilevel CSM.

ABBREVIATIONS

ACDF = anterior cervical decompression and fusion; ACPC = anterior cage-plate construct; AP = anteroposterior; ASD = adjacent-segment degeneration; CA = cervical alignment; CSM = cervical spondylotic myelopathy; JOA = Japanese Orthopaedic Association; NDI = Neck Disability Index; SA = segmental alignment; VAS = visual analog scale; ZP = zero-profile.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Liangbin Gao: Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. gaoliangbin@yeah.net.

INCLUDE WHEN CITING Published online June 4, 2021; DOI: 10.3171/2020.11.SPINE201319.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Fehlings MG, Wilson JR, Kopjar B, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am. 2013;95(18):16511658.

    • Search Google Scholar
    • Export Citation
  • 2

    Wu JC, Ko CC, Yen YS, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35(1):E10.

    • Search Google Scholar
    • Export Citation
  • 3

    Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607624.

    • Search Google Scholar
    • Export Citation
  • 4

    Cloward RB. Cervical diskography; technique, indications and use in diagnosis of ruptured cervical disks. Am J Roentgenol Radium Ther Nucl Med. 1958;79(4):563574.

    • Search Google Scholar
    • Export Citation
  • 5

    Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976). 2009;34(7):641646.

    • Search Google Scholar
    • Export Citation
  • 6

    Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976). 2009;34(26):28862892.

    • Search Google Scholar
    • Export Citation
  • 7

    Böhler J, Gaudernak T. Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma. 1980;20(3):203205.

    • Search Google Scholar
    • Export Citation
  • 8

    Kaiser MG, Haid RW Jr, Subach BR, et al. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229238.

    • Search Google Scholar
    • Export Citation
  • 9

    Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):24532458.

    • Search Google Scholar
    • Export Citation
  • 10

    Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007;32(21):23102317.

    • Search Google Scholar
    • Export Citation
  • 11

    Kasimatis GB, Panagiotopoulos E, Gliatis J, et al. Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg. 2009;111(1):1827.

    • Search Google Scholar
    • Export Citation
  • 12

    Sahjpaul RL. Esophageal perforation from anterior cervical screw migration. Surg Neurol. 2007;68(2):205210.

  • 13

    Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005;87(3):558563.

    • Search Google Scholar
    • Export Citation
  • 14

    Chen Y, Liu Y, Chen H, et al. Comparison of curvature between the Zero-P spacer and traditional cage and plate after 3-level anterior cervical discectomy and fusion: mid-term results. Clin Spine Surg. 2017;30(8):E1111E1116.

    • Search Google Scholar
    • Export Citation
  • 15

    Bartolomei JC, Theodore N, Sonntag VK. Adjacent level degeneration after anterior cervical fusion: a clinical review. Neurosurg Clin N Am. 2005;16(4):575587, v.

    • Search Google Scholar
    • Export Citation
  • 16

    Qi M, Chen H, Liu Y, et al. The use of a zero-profile device compared with an anterior plate and cage in the treatment of patients with symptomatic cervical spondylosis: a preliminary clinical investigation. Bone Joint J. 2013;95-B(4):543547.

    • Search Google Scholar
    • Export Citation
  • 17

    Chen Y, Chen H, Cao P, Yuan W. Anterior cervical interbody fusion with the Zero-P spacer: mid-term results of two-level fusion. Eur Spine J. 2015;24(8):16661672.

    • Search Google Scholar
    • Export Citation
  • 18

    Lee YS, Kim YB, Park SW. Does a zero-profile anchored cage offer additional stabilization as anterior cervical plate? Spine (Phila Pa 1976). 2015;40(10):E563E570.

    • Search Google Scholar
    • Export Citation
  • 19

    Scholz M, Schleicher P, Pabst S, Kandziora F. A zero-profile anchored spacer in multilevel cervical anterior interbody fusion: biomechanical comparison to established fixation techniques. Spine (Phila Pa 1976). 2015;40(7):E375E380.

    • Search Google Scholar
    • Export Citation
  • 20

    Clavenna AL, Beutler WJ, Gudipally M, et al. The biomechanical stability of a novel spacer with integrated plate in contiguous two-level and three-level ACDF models: an in vitro cadaveric study. Spine J. 2012;12(2):157163.

    • Search Google Scholar
    • Export Citation
  • 21

    Chen Z, Wei X, Li F, et al. Tracheal traction exercise reduces the occurrence of postoperative dysphagia after anterior cervical spine surgery. Spine (Phila Pa 1976). 2012;37(15):12921296.

    • Search Google Scholar
    • Export Citation
  • 22

    Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire: part 3. Determination of reliability. J Orthop Sci. 2007;12(4):321326.

    • Search Google Scholar
    • Export Citation
  • 23

    Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14(7):409415.

  • 24

    Gercek E, Arlet V, Delisle J, Marchesi D. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J. 2003;12(5):513516.

    • Search Google Scholar
    • Export Citation
  • 25

    Fujibayashi S, Neo M, Nakamura T. Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc herniation: sequential changes in cage subsidence. J Clin Neurosci. 2008;15(9):10171022.

    • Search Google Scholar
    • Export Citation
  • 26

    Gazzeri R, Tamorri M, Faiola A, Gazzeri G. Delayed migration of a screw into the gastrointestinal tract after anterior cervical spine plating. Spine (Phila Pa 1976). 2008;33(8):E268E271.

    • Search Google Scholar
    • Export Citation
  • 27

    Bydon M, Xu R, Macki M, et al. Adjacent segment disease after anterior cervical discectomy and fusion in a large series. Neurosurgery. 2014;74(2):139146.

    • Search Google Scholar
    • Export Citation
  • 28

    Shi S, Liu ZD, Li XF, et al. Comparison of plate-cage construct and stand-alone anchored spacer in the surgical treatment of three-level cervical spondylotic myelopathy: a preliminary clinical study. Spine J. 2015;15(9):19731980.

    • Search Google Scholar
    • Export Citation
  • 29

    Duan Y, Yang Y, Wang Y, et al. Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: a meta-analysis. J Clin Neurosci. 2016;33:1118.

    • Search Google Scholar
    • Export Citation
  • 30

    Sun Z, Liu Z, Hu W, et al. Zero-profile versus cage and plate in anterior cervical discectomy and fusion with a minimum 2 years of follow-up: a meta-analysis. World Neurosurg. 2018;120:e551e561.

    • Search Google Scholar
    • Export Citation
  • 31

    Miyazaki M, Hong SW, Yoon SH, et al. Kinematic analysis of the relationship between the grade of disc degeneration and motion unit of the cervical spine. Spine (Phila Pa 1976). 2008;33(2):187193.

    • Search Google Scholar
    • Export Citation
  • 32

    Starmer HM, Riley LH III, Hillel AT, et al. Dysphagia, short-term outcomes, and cost of care after anterior cervical disc surgery. Dysphagia. 2014;29(1):6877.

    • Search Google Scholar
    • Export Citation
  • 33

    Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014;14(9):22462260.

    • Search Google Scholar
    • Export Citation
  • 34

    Wang ZD, Zhu RF, Yang HL, et al. The application of a zero-profile implant in anterior cervical discectomy and fusion. J Clin Neurosci. 2014;21(3):462466.

    • Search Google Scholar
    • Export Citation
  • 35

    Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29(13):14411446.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1152 1152 1152
Full Text Views 66 66 66
PDF Downloads 75 75 75
EPUB Downloads 0 0 0