The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate: a systematic review and meta-analysis

Sandes

et al. 2020

Preprint

Background: Anterior access to the cervical spine is considered safe, with the most common complication being dysphagia. The objective of this study is to describe early complications of anterior cervical fusion using Zero-profile implants in a neurosurgery department and compare these with the literature. Methods: In a retrospective study, we analyzed data of patients diagnosed with cervical spondylodiscoarthrosis at a single center between January 2011 and January 2017 who underwent anterior cervical fusion using Zero-profile implants. The analyzed demographic data included age, sex, symptoms, number of operated levels, time of preoperative symptoms, type of symptom and length of hospital stay. Immediate postoperative complications were noted. Results: A total of 193 consecutively operated patients were included. Of the total, 106 patients were female (54.9%). The average age of the patients was 52.7 years. Average hospitalization was 3.20 days and the average number of levels was 1.68. Complications were noted in 57 patients (29.5%). Older patients had more complications (mean 55.5 years versus 51.5). The average length of stay was longer for patients with complications. The average number of operated levels was 1.84 in patients with complications and 1.61 in those who did not complicate. The most common complications were dysphagia (9.32%) and dysphonia (5.69%). We had 1 case of C5 monoparesis and 1 case of epidural hematoma, considered serious complications. Conclusions: Postoperative dysphagia and dysphonia were the most common complications in our series. Risk factors for complications were advanced age and number of operated levels.

Section: Discussionmentioning

confidence: 91%

“…The stability and effectiveness of Zero-profile implants are comparable to those of the classical technique using plates and screws. 3 In this study, we described early complications of anterior cervical fusion using Zero-profile implants in a neurosurgery department and compared these with the complications reported in literature.…”

Section: Introductionmentioning

confidence: 99%

Early Complications of Anterior Cervical Fusion Using Zero-profile Implants: Analysis of 193 Consecutive Cases

Sandes

et al. 2020

Preprint

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

“…The cage design assumes an elimination of disadvantages of the conventional cervical plates and maintenance of their benefits 2,3 . Stated advantages of anchored interbody cages include a reduction of postoperative adhesions, reduction of postoperative dysphagia, smaller surgical approach, shorter duration of surgery and a prevention of adjacent segment ossification when compared to those after the use of cages fixed by the conventional plate [3][4][5][6][7][8][9][10] .…”

Section: Discussionmentioning

confidence: 99%

Change in sagittal profile after implantation of anchored interbody cage in the surgical procedure for degenerative cervical spine disease

Opšenák¹,

Hanko²,

Snopko³

et al. 2021

Background. The aim of this study was to verify the relationship between changes in the segmental sagittal profile (SSP) and changes in the global sagittal profile (GSP) after anterior cervical discectomy with anchored cage implantation (ACDF). Study design. Prospective study with 2-year follow-up. Methods. This study includes 104 patients after 1-level or 2-level ACDF operated between the May 2013 and March 2016. SSP was evaluated by Cobb angle measurement of operated motion segment (CobbS) and GSP was evaluated by Cobb angle measurement in C2-C7 segments (CobbG). Both SSP and GSP were measured pre-and postoperatively within a 24 months follow-up period. The influence of factors such as age, gender, number of treated segments and osteoporosis was evaluated using t-tests. The correlation between SSP and GSP changes was assessed by Pearson's correlation coefficient. Results. In the early postoperative period after 1-level ACDF, there was a significantly greater increase in CobbS compared to that of the 2-level ACDF (P=0.0149). Male patients experienced a significant decrease of CobbG during the first 6 months after surgery as well as patients with osteoporosis within 12 months after ACDF. After ACDF the SSP change weakly correlated with the GSP change. Conclusion. SSP change after 1-or 2-level ACDF correlates mostly weakly with GSP change. Male gender and osteoporosis were identified as risk factors for global lordotisation following ACDF.

“…Currently, cage and plate constructs, stand-alone cage, and so on are widely used. The advantages of cage and plate constructs include a higher fusion rate, disc height restoration, as well as better cervical lordosis, and alignment 29) . However, using cage and plate constructs involves a further risk of hardware-related operative and postoperative complications, such as screw or plate displacement, soft tissue damage, esophageal perforation, and chronic dysphagia, which have been reported particularly if bulky plates are used 31) .…”

Section: Discussionmentioning

confidence: 99%

“…Zero-P can increase the immediate stability of the treated segment even in the absence of an anterior implant, as well as decrease the incidence of postoperative dysphagia and adjacent segments degeneration 29) . However, using Zero-P has been reported to be associated with a high subsidence rate (22.8-35.9%) 18,29) . The present study aimed to evaluate the risk factors associated with subsidence after ACDF using a Zero-P device.…”

Section: Introductionmentioning

confidence: 99%

Subsidence after Anterior Cervical Interbody Fusion Using a Zero-Profile Device

Kang¹,

Oh²,

Cho³

2019

Nerve

Zero-profile device (Zero-P) has generally been used as a stand-alone cage in anterior cervical discectomy and fusion (ACDF). However, using Zero-P has been reported to be associated with a high subsidence rate. The present study evaluates the factors that influence the subsidence of ACDF. Methods: Records of a total of 29 patients with degenerative spondylosis resulting in radiculopathy or myelopathy between C2 and C7 who underwent ACDF with Zero-P were retrospectively reviewed. The participants received 1 or 2 level ACDF with Zero-P in our clinic from December, 2011 to December, 2017. A total of 35 treatment levels were included in the analysis. Subsidence was defined when anterior segmental heights decreased by more than 2 mm during the follow-up period. The patients were divided into the subsidence and non-subsidence groups. The following factors were investigated in relation to the occurrence of subsidence: age, gender, body mass index, diabetes mellitus, cage height, perioperative distraction, segmental lordosis, pain score, fusion grade, anterior/posterior segmental height ratio, and cage distance. Results: Cage subsidence was observed in 15 cases (15/35, 42%). Cage distance at immediate postoperation was significantly different between the 2 groups; specifically, while the group with subsidence had 2.66±1.62 mm distance, the group without subsidence had 1.24±1.13 mm distance (p=0.008). Conclusion: This study confirms that the more deeply titanium part is inserted at the anterior edge, the more subsidence occurs. In order to decrease the occurrence of cage subsidence, Zero-P cages should be located the closest possible to the anterior rim of vertebral body at operation.