Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis

Zhang, Duo; Liu, Baoge; Zhu, Jichao; Li, Chenxi; Fengning, Wei; Yuan, Yuan; Zhu, Di

doi:10.1016/j.wneu.2018.12.218

Cited by 31 publications

(41 citation statements)

References 52 publications

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“…Moreover, it was reported that increased rigidity of adjacent segment and abnormal sagittal balance after ACDF promotes ASD [28]. While in our study, neither in ACP group nor in NIM subgroup, the incidence of ASD was comparable contrasted to another, which administrated ASD might not be directly derived from increased rigidity of adjacent segment or sagittal imbalance and was consistent with the opinion of Zhang et al [24].…”

Section: Discussionsupporting

confidence: 91%

“…Studies have shown that the presence of a plate was more likely to accelerate degenerative changes in adjacent segments [16,23]. However, a meta-analysis performed by Zhang et al [24] showed that there was no statistically significant difference in ASD incidence between the SSC and ACP groups with a multilevel ACDF with a short-term visit. Therefore, the precise cause of ASD was still unknown.…”

Section: Discussionmentioning

confidence: 97%

“…In this study, no identified correlation was drawn between clinical outcomes and the change of CL after both procedures. Despite different types of cage and fixation, both procedures decompressed spinal cord directly by removing the anterior pathogenic compression [24]. Although the volume of spinal canal could be effected by CL[7], there was adequate compensated space for spinal cord recruitment after decompression.…”

Section: Discussionmentioning

confidence: 99%

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Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

Xu¹,

Yu²,

Zhu³

et al. 2020

Preprint

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Purpose: To identify the importance of sagittal alignment with self-locked stand-alone cage (SSC) and anterior cage-with-plate (ACP) system after 3-level anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) after minimal 5-year follow-up.Methods: 38 patients with SSC system (SSC group) and 26 with ACP system (ACP group) from February 2007 to September 2013 were enrolled. Cervical alignment were C2-7 lordosis (CL), operated-segment CL (OPCL), upper and lower adjacent-segment CL (UCL and LCL) at preoperation (POP), immediate postoperation (IPO) and final follow-up (FFU). Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score and adjacent segment degeneration (ASD). Patients were divides into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).Results: There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P<0.05) but UAL and LAL were of no significance. NDI and JOA got improvement in both groups at IPO and FFU while ASD was in no difference between SSC and ACP. A total of 40 patients (18 vs 22) acquired CL improvement with a larger population in ACP group. There were no differences on the rate if ASD, NDI, JOA and their change between IM and NIM subgroup and the change of CL were not correlated with NDI, JOA and their change.Conclusion: SSC and ACP both provide long-term efficacy on OPCL correction with little impact on adjacent segment. The improvement of CL after three-level ACDF seems not so essential.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

Xu¹,

Yu²,

Zhu³

et al. 2020

Preprint

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“…In the ACDF procedure, directed decompression of the nucleus pulposus and osteophyte can be performed under clear vision during operation [2]. Meanwhile, the physical sagittal alignment of cervical spine can be restored with the inserted cage in the intervertebral space, fixed screws, and anterior plates [3]. However, a solid bony fusion in this procedure can change the range of motion (ROM) and mechanical load of adjacent segments, which can cause subsequent adjacent segment disease (ASD) [4].…”

Section: Introductionmentioning

confidence: 99%

Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis

Zhang

et al. 2020

BMC Neurol

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Background: This meta-analysis was designed to investigate the long-term efficacy and safety between cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in treating cervical disc degenerative diseases (CDDDs). Methods: Literature search was performed on Pubmed, Embase, Cochrane Library, and Web of Science before Jan 2019. Surgical details, clinical outcomes, range of motion (ROM), complications, and reoperation rates between CDA and ACDF groups were compared and analyzed. A fixed-or random-effects model was applied based on different heterogeneity. STATA (Version 11.0) software was used to perform data analysis. Results: A total of 13 randomized controlled trial studies with more than 60 months of follow-up (mean 83.1 months) were enrolled in this meta-analysis. Pool results indicated that the CDA group exhibited significantly better outcomes in clinical scores (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.15-2.08, p = 0.004) and preservation of ROM (mean difference = 1.77, 95% CI: 1.60-1.95, p < 0.001) than the ACDF group. Meanwhile, the incidence of adjacent segment disease (ASD) (OR = 0.51, 95% CI: 0.35-0.76, p = 0.001) and occurrence of reoperation (OR = 0.41, 95% CI: 0.25-0.69, p = 0.001) were lower in the CDA group than in the ACDF group.

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“…Studies have shown that anierior plate is more likely to accelerate degenerative changes in adjacent segments [16]. However, a meta-analysis performed by Zhang et al [17] showed no difference in ASD incidence between the SSC and ACP groups with a multilevel ACDF. Our data showed a long-term incidence of 70% on ASD with no intergroup signi cance, in consistence with Zhang et al In addition, no case here underwent reoperation for adjacent segment pathology indicated a comparable and limited impact on ASD progression.…”

Section: Discussionmentioning

confidence: 97%

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

Yang

Liu

et al. 2020

Preprint

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Purpose Cervical alignment between self-locked cage (SLC) and anterior cage-with-plate (ACP) system was debatable, especially in multilevel anterior cervical discectomy and fusion (ACDF). T1 slope minus C2-C7 cervical lordosis (T1S-CL) was critical for cervical-balance while without identified threshold. Thus the study was to compare sagittal alignment between SLC and ACP on 3-level ACDF and to identify the threshold of T1S-CL in 3-level ACDF. Methods 45 patients of 3-level SLC and 28 cases of 3-level ACP with well-matched demographics were retrospectively enrolled with 6.1-year follow-up. Cervical alignment paramters were CL, C2-C7 sagittal vertical axis (C2-C7 SVA), T1S and T1S-CL, as well as adjacent segment degeneration (ASD), obtained on X-ray. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were recorded for evaluating quality of life (QOL). NDI of 20 was difined as the cutoff of QOL. Threshold of T1S-CL was determined by both linear and logistic regression model. Result CL, C2-C7 SVA and T1S were insignificant at baseline and all parameters were indifferent at last (P ˃0.05). CL and T1S improved at last in both groups (P < 0.05). The incidence of ASD was comparable between groups (P ˃0.05). Both groups acquired inprovement on NDI and JOA (P < 0.001). There were close correlation among alignment paramters and between parameters and NDI at final follow-up. C2-C7 SVA was independent risk factor for NDI and two regression models predicted C2-C7 SVA with a cutoff of 29.2 mm, corresponded to the threshold on T1S-CL of 20.7°. Conclusions It is comparable on alignment reconstruction between SLC and ACP system. The cutoff on C2-C7 SVA with 29.2 mm corresponds to a thershold of T1S-CL with 20.7° in multilevel ACDF.

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Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis

Cited by 31 publications

References 52 publications

Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

Is the improvement of cervical alignment really essential after three-level anterior cervical discectomy and fusion? A minimal 5-year follow-up

Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

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