Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion

Xiao, Shan-Wen; Liang, ZhuDe; Wu, Wei; Ning, Jinpei

doi:10.1007/s00586-016-4914-5

Cited by 44 publications

(34 citation statements)

References 49 publications

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“…McAfee [ 10 ] performed a prospective randomized on the same topic and draw the same conclusion. Xiao [ 11 ] found that Zero profile could reduce the incidence of postoperative dysphagia compared with ACDF. We also observed 4 anterior surgical plans, including ACDF, ACCF, ACCDF, and Zero profile.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting dysphagia after anterior cervical surgery

Wang

Yang

et al. 2017

Medicine

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A multicenter retrospective study.The purpose of this study was to explore risk factors of dysphagia after anterior cervical surgery and factors affecting rehabilitation of dysphagia 2 years after surgery.Patients who underwent anterior cervical surgery at 3 centers from January 2010 to January 2013 were included. The possible factors included 3 aspects: demographic variables—age, sex, body mass index (BMI): hypertension, diabetes, heart disease, smoking, alcohol use, diagnose (cervical spondylotic myelopathy or ossification of posterior longitudinal ligament), preoperative visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), surgical-related variables—surgical option (ACDF, ACCF, ACCDF, or Zero profile), operation time, blood loss, operative level, superior fusion segment, incision length, angle of C2 to C7, height of C2 to C7, cervical circumference, cervical circumference/height of C2 to C7.The results of our study indicated that the rate of dysphagia at 0, 3, 6, 12, and 24 months after surgery was 20%, 5.4%, 2.4%, 1.1%, and 0.4%, respectively. Our results showed that age (58.8 years old), BMI (27.3 kg/m2), course of disease (11.6 months), operation time (103.2 min), blood loss (151.6 mL), incision length (9.1 cm), cervical circumference (46.8 cm), angle of C2 to C7 (15.3°), cervical circumference/height of C2 to C7 (4.8), preoperative VAS (7.5), and ODI (0.6) in dysphagia group were significantly higher than those (52.0, 24.6, 8.6, 88.2, 121.6, 8.6, 42.3, 12.6, 3.7, 5.6, and 0.4, respectively) in nondysphagia group; however, height of C2 to C7 (9.9 vs 11.7 cm) and preoperative JOA (8.3 vs 10.7) had opposite trend between 2 groups. We could also infer that female, smoking, diabetes, ossification of posterior longitudinal ligament, ACCDF, multilevel surgery, and superior fusion segment including C2 to C3 or C6 to C7 were the risk factors for dysphagia after surgery immediately. However, till 2 years after surgery, only 2 risk factors, smoking and diabetes, could slow rehabilitation of dysphagia.Many factors could significantly increase rate of dysphagia after anterior cervical surgery. Operation time as a vital factor markedly increases immediate postoperative dysphagia and smoking, as the most important factor, lower recovery of dysphagia. Further study is needed to prove if these factors could influence dysphagia.

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Section: Discussionmentioning

confidence: 99%

Factors predicting dysphagia after anterior cervical surgery

Wang

Yang

et al. 2017

Medicine

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“…Additionally, we found that the incidence of dysphagia in the CP group was significantly higher than that in the ZP group at each follow-up time, which was consistent with previous studies. Xiao et al [30] The results of this study suggested that the ZP group was associated with a high incidence of subsidence, when compared with the CP group. Considering the different definitions of subsidence used in the above ten studies, we conducted subgroup analysis of subsidence defined as ≥ 2mm and subsidence defined as ≥ 3mm.…”

Section: Discussionmentioning

confidence: 56%

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Fang

Shen

et al. 2020

Preprint

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Background: The zero-profile anchored cage ( ZP ) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate. Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software. Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time. Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.

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“…This theoretical advantage would also be present in disc arthroplasty because there is no instrumentation protruding from the spine. A recent meta‐analysis reported lower rates of dysphagia after 1 year in patients with zero‐profile plates compared to conventional ACDF plating . None of the ZTD patients with pharyngoesophageal perforations had zero‐profile implants, isolated corpectomy, or disc arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

et al. 2019

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Objectives: A Zenker's diverticulum (ZD) is a hypopharyngeal pulsion diverticula caused by dysfunction of the cricopharyngeus muscle with herniation of hypopharyngeal mucosa through Killian's dehiscence. Anterior cervical spine surgery (ACSS) can cause a Zenker's-like traction diverticulum (ZTD) with a similar presentation but different pathophysiology. The purpose of this investigation was to compare the fluoroscopic parameters and surgical outcomes of ZTD after ACSS to those of typical ZD.Study Design: Case-control study. Methods: The charts of patients undergoing a videofluoroscopic swallow study after ACSS between January 1, 2014, and January 1, 2018, were evaluated for evidence of ZTD. Patients with ZTD were age and gender matched to persons with ZD. Fluoroscopic parameters and patient-reported outcomes were compared between groups.Results: Eleven patients with ZTD were identified. The mean pharyngeal constriction ratio (PCR) was significantly higher for persons with ZTD (0.87 [AE0.07] vs. 0.17 [AE0.08]; P < 0.05). Mean hyolaryngeal elevation was significantly less (2.5 [AE0.9] cm vs. 3.5 [AE0.7] cm) and mean diverticulum size significantly smaller (1.3 [AE1.0] cm vs. 2.3 [AE2.0] cm) for persons with ZTD (P < 0.05). Five ZTD patients had exposed hardware necessitating open approach for removal.Conclusion: We report the largest cohort of ZTD after ACSS. ZTD are smaller than traditional Zenker's and associated with more pharyngeal weakness, poorer laryngeal elevation, and worse treatment outcomes. Although these diverticula can be managed endoscopically, the high percentage of exposed cervical hardware necessitates a thorough preoperative assessment and frequent need for open management and pharyngeal repair.

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Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion

Abstract: Zero-profile anchored cage had a lower risk of postoperative dysphagia than cage with plate.

Cited by 44 publications

References 49 publications

Factors predicting dysphagia after anterior cervical surgery

Factors predicting dysphagia after anterior cervical surgery

Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis

Swallowing Characteristics in Zenker's‐like Diverticulum After Anterior Cervical Spine Surgery

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