4:1496. The influence of anterior cervical plate design on dysphagia: a prospective longitudinal cohort study

Lee, Michael; Bazaz, Raj; Furey, Christopher G.; Yoo, Jung U.

doi:10.1016/j.spinee.2005.05.098

Cited by 68 publications

(98 citation statements)

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“…Such experience is similar to that reported by Tortolani et al [37], although other studies suggest that the more cranial the operated disc level (i.e., C3-C4) the higher is the risk of postoperative dysphagia, or just fail to demonstrate any correlation with the level of surgery [5,11,41]. Even the thickness of plates has been correlated with the dysphagia rate, this being lower when thin, low-profile plates are used [20].…”

Section: Discussionsupporting

confidence: 81%

“…In our experience the Zero-P device was associated with a reduced rate of dysphagia (only two cases of mild and three of moderate dysphagia) in the postoperative course (15.5 %); indeed, the Zero-P is contained within the disc space and does not protrude past the anterior wall of the vertebral body, avoiding a direct contact with the tracheoesophageal soft tissues. In particular, the zero profile of the device is fundamental to avoid a mechanical irritation of the esophagus, one of the known main device-related causes of chronic dysphagia [20]. It should be pointed out that in our series the three patients suffering from postoperative moderate dysphagia had undergone surgery at C4-C5 or C5-C6, either as single-or multiple-level surgery.…”

Section: Discussionmentioning

confidence: 98%

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Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

et al. 2013

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Purpose To analyze the prospectively collected data in a series of patients treated with single-or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinicoradiological outcome, complications and technical hints, and to review the literature on such new devices. Methods Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2-4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis. Results SF-36 and NDI showed a statistically significant improvement (p \ 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a ''focal spondylectomy'' was required. Conclusion The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 98%

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

et al. 2013

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“…27,30 Application of a cervical plate has gained acceptance as a means of increasing fusion rates and preventing graft dislodgement, but it can be expensive and has been associated with complications such as dysphagia, infection, and instrumentation failure. 4,13,23,24 Instrumented fusion is also associated with a significantly higher amount of intraoperative blood loss when compared with procedures in which plate fixation is not used. 31 The effectiveness of plate fixation in single-level ACDF is controversial, and there are significant differences in fusion rates among published studies.…”

Section: Discussionmentioning

confidence: 99%

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Jagannathan¹,

Shaffrey²,

Oskouian³

et al. 2008

SPI

130

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Object Although the clinical outcomes following anterior cervical discectomy and fusion (ACDF) surgery are generally good, 2 major complications are graft migration and nonunion. These complications have led some to advocate rigid internal fixation and/or cervical immobilization postoperatively. This paper examines a single-surgeon experience with single-level ACDF without use of plates or hard collars in patients with degenerative spondylosis in whom allograft was used as the fusion material. Methods The authors conducted a retrospective review of a prospective database of (Cloward-type) ACDF operations performed by the senior author (J.A.J.) between July 1996 and June 2005. Radiographic follow-up included static and flexion/extension radiographs obtained to assess fusion, focal and segmental kyphosis, and change in disc space height. At most recent follow-up, the patients' condition was evaluated by an independent physician examiner. The Odom criteria and Neck Disability Index (NDI) were used to assess outcome. Results One hundred seventy patients underwent single-level ACDF for degenerative pathology during the study period. Their most common presenting symptoms were pain, weakness, and radiculopathy; 88% of patients noted ≥ 2 neurological complaints. The mean hospital stay was 1.76 days (range 0–36 days), and 3 patients (2%) had major immediate postoperative complications requiring reoperation. The mean duration of follow-up was 22 months (range 12–124 months). Radiographic evidence of fusion was present in 160 patients (94%). Seven patients (4%) showed radiographic evidence of pseudarthrosis, and graft migration was seen in 3 patients (2%). All patients had increases in focal kyphosis at the operated level on postoperative radiographs (mean −7.4°), although segmental alignment was preserved in 133 patients (78%). Mean change in disc space height was 36.5% (range 28–53%). At most recent clinical follow-up, 122 patients (72%) had no complaints referable to cervical disease and were able to carry out their activities of daily living without impairment. The mean postoperative NDI score was 3.2 (median 3, range 0–31). Conclusions Single-level ACDF without intraoperative plate placement or the use of a postoperative collar is an effective treatment for cervical spondylosis. Although there is evidence of focal kyphosis and loss of disc space height, radiographic evidence of fusion is comparable to that attained with plate fixation, and the rate of clinical improvement is high.

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“…28 Lee et al found a correlation between greater plate thickness and an increased incidence of dysphagia. 23 During the early postoperative period, up to 67% of patients may complain of difficulty swallowing. 16,18,27,40,41 In most cases, the dysphagia resolves during the first 3 months after surgery; 3,23 however, a subset of patients may continue to have chronic dysphagia after ACDF, with rates up to 35%.…”

mentioning

confidence: 99%

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

Njoku

Alimi

Leng

et al. 2014

SPI

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Object Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia. Methods Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well. Results Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2–19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0–10) to 0 (range 0–8; p < 0.001). The arm VAS score improved from a median of 2 (range 0–10) to 0 (range 0–7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0–3) immediately postoperatively to 0 (range 0–2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score. Conclusions A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.

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4:1496. The influence of anterior cervical plate design on dysphagia: a prospective longitudinal cohort study

Cited by 68 publications

References 0 publications

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar

Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study

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