Comparison of Patient-Reported Postoperative Dysphagia in Patients Undergoing One-Level Versus Two-Level Anterior Cervical Discectomy and Fusion with the Zero-P Implant System

Huang, Chengyi; Abudouaini, Haimiti; Wang, Beiyu; Ding, Chen; Meng, Yang; Yang, Yi; Wu, Tingkui; Líu, Hao

doi:10.1007/s00455-020-10197-w

Cited by 10 publications

(8 citation statements)

References 42 publications

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“…Compared to the zero-profile and plate-cage, the low profile preserves the anterior panel to improve cervical stability, reduce subsidence, and improve the fusion rate. It also reduces the profile of the anterior panel, thereby reducing mechanical irritation to the esophagus and reducing the risk of postoperative dysphagia [ 38 ]. Five patients (12.8%) who underwent the anterior approach had transient dysphagia one week postoperatively but recovered after subsequent treatment.…”

Section: Discussionmentioning

confidence: 99%

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

Zou

Zhang

Yang

et al. 2023

JCM

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(1) Background: The choice of surgical access for 4-level degenerative cervical myelopathy (DCM) remains controversial, and the clinical and radiological outcomes of anterior surgery using a low-profile cage (Low-P) versus posterior surgery using cervical pedicle screw fixation (CPS) have not been compared. (2) Methods: This is a retrospective controlled study conducted between January 2019 and June 2021 of 72 patients with 4-level DCM who underwent ACDF using a low-profile cage (n = 39) or laminectomy and instrument fusion using CPS (n = 33). The minimum follow-up time was 12 months. The outcomes were C2–7Cobb angle, C2–7sagittal vertical axis (SVA) fusion rate, the Japanese Orthopedic Association (JOA) score, pain visual analog scale (VAS), neck disability index (NDI), and complications. (3) Results: Both anterior and posterior procedures significantly improved the patients’ quality-of-life parameters. Anterior cervical convexity and SVA significantly increased in both groups, but the SVA was greater in the posterior group than in the anterior group (p < 0.001). The C2–7 Cobb angle significantly improved in both groups postoperatively, and at the final follow-up, there was a slight but nonsignificant reduction in cervical lordosis in both groups (p = 0.567). There was a longer operative time, less intraoperative blood loss, and reduced mean hospital stay in the anterior group compared to the posterior group, with two cases of postoperative hematoma requiring a second operation, two cases of axial pain (AP), five cases of dysphagia, two cases of c5 palsy in the anterior group, and four cases of axial pain, and three cases of c5 palsy in the posterior group. According to Bridwell fusion grade, anterior fusion reached grade I in 28 cases (71.8%) and grade II in 10 cases (25.6%) in the anterior group, and posterior fusion reached grade I in 25 cases (75.8%) and grade II in 8 cases (24.2%) in the posterior group. (4) Conclusions: There was no difference between the anterior and posterior surgical approaches for MDCM in terms of improvement in neurological function. Posterior surgery using CPS achieved similar recovery of cervical anterior convexity as anterior surgery with a shorter operative time but was more invasive and had a greater increase in SVA. The use of Low-P in anterior surgery reduced the incidence of dysphagia and cage subsidence and was less invasive, but with a longer operative time.

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Section: Discussionmentioning

confidence: 99%

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

Zou

Zhang

Yang

et al. 2023

JCM

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“…A variety of variables have been implicated in the development of dysphagia following ACDF, but the exact reasons remain unknown. According to prior research, dysphagia is more common with older age ( 3 , 38 ), unfavorable postoperative C2–C7 angle ( 39 ), pre-pneumonectomy ( 40 ), two-level surgery ( 9 , 41 ), long operation time ( 36 ), and greater prevertebral soft tissue swelling ( 9 , 42 ). Further research on dysphagia mechanisms and techniques for reducing the occurrence of dysphagia are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…By contrast, immediate postoperative stabilization the core advantage of a ZP cage and an ACP system ( 8 ). Unlike the latter, the ZP cage has an additional anchoring function, which ensures less protrusion in front of the vertebral body, thereby placing less compression on the esophagus and ultimately decreasing the risk of postoperative dysphagia ( 9 , 10 ). Due to the ability to overcome these disadvantages of the ST cage and ACP construct, the use of zero-profile cages in ACDF is gradually increasing.…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study

Chen²,

Fu³

et al. 2022

Front. Surg.

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ObjectiveTo assess the mid-long-term clinical and radiological outcomes of zero-profile (ZP) compared with stand-alone (ST) cages for two-level anterior cervical discectomy and fusion (ACDF).MethodsWe included 77 patients (39 women and 38 men) who underwent two-level ACDF between May 5, 2016, and May 5, 2020, and who were followed up for at least 1 year. The subjects were divided into the ST (n = 38) and ZP (n = 39) group. For the evaluation of functional status, Japanese Orthopedic Association (JOA), Neck Disability Index (NDI), and Visual Analogue Scale (VAS) scores were used. Additionally, radiological outcomes and procedure complications were observed at final follow-up.ResultsBoth groups had excellent clinical outcomes at the final follow-up. There were no significant intergroup (ZP vs. ST) differences in the fusion rate (91.02% vs. 90.79%, P > 0.05) and postoperative dysphagia (15.4% vs. 2.6%, P = 0.108). However, the disc height at the final follow-up in the ZP group was higher than that in the ST group (6.86 ± 0.84 vs. 6.17 ± 1.03, P = 0.002). The ZP group accomplished a lower loss of cervical lordosis (18.46 ± 4.78 vs. 16.55 ± 4.36, P = 0.071), but without reaching statistical significance.ConclusionACDF with either ZP or ST cages turns out to be a dependable strategy for two-level ACDF in terms of clinical results. However, compared with the ST, the ZP cage may achieve a significantly lower loss of disc height.

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“…Therefore, we chose a zero‐profile implant in this patient. According to Huang, 19 the incidence of dysphagia was significantly greater in patients undergoing two‐level anterior cervical discectomy and fusion with zero‐profile than those in the one‐level group. Moreover, it has been shown that degeneration of the intermediate segment following noncontiguous anterior cervical fusion is faster than that of the supra‐ or infra‐adjacent segments 20–22 .…”

Section: Discussionmentioning

confidence: 99%

Zero‐Profile Implant System for Treatment of Dysphagia Caused by Noncontiguous Anterior Cervical Osteophytes—A Case Report with Literature Review

Peng

Liu

Hong

et al. 2022

Orthopaedic Surgery

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Background: Esophageal cervical spondylosis is a rare type of cervical spondylosis which causes dysphagia. Surgical osteophyte resection is taken when conservative treatment does not respond. However, few reports on its operation and postoperative follow-up. We first present a case showing how the Zero-Profile implant system is utilized to treat dysphagia caused by noncontiguous anterior cervical osteophytes.Case Presentation: A patient with progressive dysphagia was referred to our department. Imaging examinations revealed a large diffuse idiopathic skeletal hyperostosis (DISH) related anterior osteophyte in C3/4, C6/7 and ossification of the anterior and posterior longitudinal ligaments. Anterior cervical osteophytectomy, discectomy, and fusion were performed on C3/4, C6/7. Two Zero-Profile implants were implanted. Postoperative dysphagia was significantly improved, and the patient was free to swallow large pills or solid foods at nine-years follow-up. Conclusion:Osteophyte excision can effectively treat esophageal cervical spondylosis, This case shows that fusion using the Zero-Profile implant system is a viable option for patients with potential cervical instability following osteophyte resection.

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Comparison of Patient-Reported Postoperative Dysphagia in Patients Undergoing One-Level Versus Two-Level Anterior Cervical Discectomy and Fusion with the Zero-P Implant System

Cited by 10 publications

References 42 publications

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: A retrospective cohort study

Zero‐Profile Implant System for Treatment of Dysphagia Caused by Noncontiguous Anterior Cervical Osteophytes—A Case Report with Literature Review

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