Outcomes Evaluation of Zero-Profile Devices Compared to Stand-Alone PEEK Cages for the Treatment of Three- and Four-Level Cervical Disc Disease

Gerszten, Peter C.; Paschel, Erin; Mashaly, Hazem; Sabry, Hatem; Jalalod’din, Hasan; Saoud, Khaled

doi:10.7759/cureus.775

Cited by 14 publications

(18 citation statements)

References 31 publications

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“…However, in most cases and in most of the studies, this remains asymptomatic. Gerszten et al [1] evaluated the results of multi-level ACDF using stand-alone cages and zero-profile instrumentation and concluded that both techniques are safe and effective, comparable with the reports that used plates [25]. The safety of stand-alone cages has been studied in a large cohort of patients as discussed in the literature [9].…”

Section: Radiological Outcomesmentioning

confidence: 96%

“…Multi-level disc disease of the cervical spine represents a challenging problem. Although a variety of anterior, posterior, and combined approaches have been advocated for multi-level cervical disc disease, the anterior approach still represents the preferable surgery in many cases as it allows for the direct decompression of the spinal cord and nerve roots as well as achieving solid fusion [ 1 ]. Multi-level cervical discectomy is often combined with anterior or posterior instrumentation to maintain the spinal curvature and increase the fusion rate [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The modern cages with built-in lordosis and the cage design that allows a better press–fit insertion of the cages provide stability even without an additional plate fixation [ 7 ]. Zero-profile implants reduce plate-associated complications such as dysphagia and loosening of the screws [ 1 , 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages

et al. 2022

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The aim of this study is to assess the long-term outcomes after performing the four-level anterior cervical discectomy and fusion (ACDF) in the treatment of degenerative cervical spine disease using stand-alone titanium cages. Overview of Literature: Over the last decades, a rapid increase in the use of stand-alone cages for ACDF has been observed. However, research on their application in the treatment of four-level diseases is insufficient. Methods: In this study, 130 patients presenting with symptomatic cervical spondylosis who underwent four-level ACDF using standalone cages in our institution between 2008 and 2016 were assessed. Fifty-two patients were women and 78 men with a mean age of 60.5 years. Their clinical and radiological outcomes were assessed. The results of the Neck Disability Index (NDI) and Visual Analog Scale as well as bony fusion were evaluated, and the revisions were analyzed. All of the patients underwent the four-level microscopic ACDF using the same titanium rectangular cage. Results: The mean follow-up was 47±11.4 months. A fusion of all four levels was achieved in 80.72% of the patients. In 25 patients (19.23%), an incomplete bony bridging was observed in at least one fusion level at the final follow-up. However, only two patients (1.5%) were symptomatic and underwent revision. The mean NDI improved significantly from 39.4±9.3 at presentation to 8.3±6.6 at the final follow-up. Cervical lordosis improved significantly from a mean of 5.5° preoperatively to a mean of 15° postoperatively. Cage sinking and loss of segment height during healing had a mean of 3 mm. Conclusions: Overall, the application of four-level ACDF using titanium cages in a stand-alone technique has been proven to be a safe and effective treatment method for degenerative disease. In a large cohort, a high rate of good long-term clinical and radiological results was achieved.

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Section: Radiological Outcomesmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages

et al. 2022

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“…After reviewing 10 studies consisting of over 700 patients in their meta-analysis, Dong et al concluded that zero-profile spacers conferred similar fusion rates, lower Neck Disability Index (NDI), and improved pain scores compared to standard anterior plating [ 28 ]. These favorable outcomes were replicated in both single level and multi-level cervical disc diseases, suggesting the safety of zero-profile spacers regardless of number of cervical levels involved [ 40 , 41 ].…”

Section: Reviewmentioning

confidence: 99%

Anterior Techniques in Managing Cervical Disc Disease

Kim

D’Souza

et al. 2018

Cureus

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Surgical treatment may be indicated for select patients with cervical disc disease, whether it is cervical disc herniation or spondylosis due to degenerative changes, acute cervical injury due to trauma, or other underlying cervical pathology. Currently, there are various surgical techniques, including anterior, posterior, or combined approaches, in addition to new interventions being utilized in practice. Ideally, the surgical approach should be selected in consideration of each patient’s clinical presentation, imaging findings, and overall medical comorbidities on an individual basis. But the unique advantages and disadvantages of each surgical technique often complicate the therapy choice in managing cervical disc diseases. Although anterior cervical discectomy and fusion (ACDF) is the most widely accepted procedure performed for both single and multi-level cervical disc diseases, there are multiple modifications to this technique. Surgeons have access to different types of plates, screws, and cages and can adopt newer advances in the field such as stand-alone and minimally invasive techniques when indicated. In short, no consensus exists in terms of a single approach that is preferred for all patients. This article aims to review the standard of care for management of cervical disc disease with a focus on the surgical techniques and, in particular, the anterior approach, exploring the various surgical options within this technique.

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“…35,40,49,57 Of note, stand-alone devices were found to be an effective treatment option for patients with up to 3-and 4-level spine disease as well. 57,58 However, one potential disadvantage of the standalone technique is an increased incidence of subsidence in the stand-alone device fusions when compared with traditional ACDF that is described in literature. [59][60][61] In this meta-analysis, NDI, VAS arm, VAS neck, and JOA scoring appeared the same between stand-alone ACDF and CDA, thus suggesting similar patient experience from the 2 treatments.…”

Section: Summary Of Evidencementioning

confidence: 99%

Outcomes After Cervical Disc Arthroplasty Versus Stand-Alone Anterior Cervical Discectomy and Fusion: A Meta-Analysis

Gendreau

Kim

Prins

et al. 2019

Global Spine Journal

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Study Design: Systemic review and meta-analysis. Objectives: To review and compare surgical outcomes for patients undergoing stand-alone anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for the treatment of cervical spine disease. Methods: A systematic search was performed on PubMed, Medline, and the Cochrane Library. Comparative trials measuring outcomes of patients undergoing CDA and stand-alone ACDF for degenerative spine disease in the last 10 years were selected for inclusion. After data extraction and quality assessment, statistical analysis was performed with R software metafor package. The random-effects model was used if there was heterogeneity between studies; otherwise, the fixed-effects model was used. Results: In total, 12 studies including 859 patients were selected for inclusion in the meta-analysis. Patients undergoing stand-alone ACDF had a statistically significant increase in postoperative segmental angles (mean difference 0.85° [95% confidence interval = 0.35° to 1.35°], P = .0008). Patients undergoing CDA had a decreased rate of developing adjacent segmental degeneration (risk ratio = 0.56 [95% confidence interval = −0.06 to 1.18], P = .0745). Neck Disability Index, Japanese Orthopedic Association score, Visual Analogue Scale of the arm and neck, as well as postoperative cervical angles were similar between the 2 treatments. Conclusions: When compared with CDA, stand-alone ACDF offers similar clinical outcomes for patients and leads to increased postoperative segmental angles. We encourage further blinded randomized trials to compare rates of adjacent segmental degeneration and other postoperative outcomes between these 2 treatments options.

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Outcomes Evaluation of Zero-Profile Devices Compared to Stand-Alone PEEK Cages for the Treatment of Three- and Four-Level Cervical Disc Disease

Cited by 14 publications

References 31 publications

Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages

Results of Four-Level Anterior Cervical Discectomy and Fusion Using Stand-Alone Interbody Titanium Cages

Anterior Techniques in Managing Cervical Disc Disease

Outcomes After Cervical Disc Arthroplasty Versus Stand-Alone Anterior Cervical Discectomy and Fusion: A Meta-Analysis

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