Application of Zero-profile Spacer in the Treatment of Three-level Cervical Spondylotic Myelopathy

Abstract

Study Design. A retrospective study. Objective. To assess the long-term results of zero-profile spacer for 3-level anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Although widely used, there are still controversies about the long-term results of zero-profile spacer, especially in multilevel cases. Methods. Cases received 3-level ACDF for cervical spondylotic myelopathy (CSM) using either zero-profile spacer (n = 27) (ZP Group), or plate and cages (n = 34) (PC Group), and with 5-year follow-up were reviewed. Neurological function and life quality were assessed by modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and Short-Form 36 (SF-36) score. Disc height, cervical lordosis, fusion rate, and surgical complications were observed. Results. Neurological recovery and life quality improvement were similar in both groups. Disc height and cervical lordosis (C2-7 Cobb angle) were well restored after operations, but lost in both groups during follow-up. Loss of correction (LOC) in disc height was larger in ZP Group (11.38% vs 5.71%, P < 0.05) at 5-year follow-up. LOC of cervical lordosis in ZP group constantly grew from 11.28% to 48.13% during 5-year follow-up, significantly higher than that in the PC group (from 7.43% to 14.01%) (P < 0.05). The rate of postoperative dysphagia was no statistical difference between the two groups, and symptoms were all disappeared within 1 year. There were 10 levels of adjacent segment degeneration (1 in ZP Group, and 10 in PC Group, P = 0.02). Cage subsidence (11 of 81 levels, 13.58%) and screw migration (2 of 81 levels, 2.47%) were only observed in the ZP Group. The migrated screws in one case were surgically removed. Fusion was achieved in all cases. Conclusions. In long-term follow-up of 3-level ACDF for CSM, zero-profile spacer has the similar clinical results, but loss of correction of disc height and cervical alignment were significantly higher, compared with anterior plate and cages. Level of Evidence: 3

Anterior Cervical Discectomy and Fusion Using Zero-P System for Treatment of Cervical Spondylosis: A Meta-Analysis

“…(1) Cervical Curvature . It was found that a total of 5 studies including 1 randomized controlled trial and 4 nonrandomized retrospective studies [ 15 , 17 , 22 , 25 , 26 ] reported C2-C7 cervical spine curvature before and after surgery ( Table 3 ).…”

“…(3) Disc Height Index (DHI) . It was found that a total of 5 original studies [ 18 – 20 , 22 , 25 ] reported the intervertebral height index and provided valid data. All the 5 studies were nonrandomized retrospective studies.…”

Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study

“…7 Recent data from the literature seem to confirm that ACDF without plating may provide clinical outcomes similar to ACDF with plating. 23 Accordingly, due to the long-term clinical benefits and the very low rate of complications, we do prefer the stand-alone cage technique in single-or double-level procedures. 16 Although all the patients included in the present investigation were prescribed to wear a nonrigid cervical collar for 4 to 6 weeks after surgery, external orthosis is no longer prescribed after ACDF surgeries at our centers, according to recent data from literature.…”

Over-correction of Curvature in Surgical Segments Cause the Non-surgical Curvature Loss in One- and Two-level Anterior Cervical Discectomy and Fusion

“…At present, ACDF is still the rst-line surgical method for the treatment of CDDD, and its surgical effect has been con rmed by clinical application for decades [1][2][3][8][9][10] . The treatment of CDDD focuses on relieving neurological symptoms and reconstructing the spinal structure [15][16][17].…”

“…Cervical disc degenerative disease (CDDD) is a common clinical spinal surgery disease, which has a great impact on the quality of life of middle-aged and elderly patients [1][2][3][4][5]. At present, although this is challenged by many new surgical treatments [5][6][7], anterior cervical discectomy and fusion (ACDF) is still the best choice for the treatment of CDDD [8][9][10]. After decades of clinical application, the clinical effect of ACDF has been fully demonstrated.…”