Anterior Cervical Discectomy and Fusion: Comparison between Zero-Profile Implants and Anterior Cervical Plate and Spacer

Abstract

Introduction Interposition grafts combined with anterior plating currently remain the gold standard for anterior cervical discectomy and fusion. The use of anterior plates increases fusion rates, but may be associated with higher rates of postoperative dysphagia. The current study aimed to compare the clinical and radiological outcomes following anterior cervical discectomy and fusion (ACDF) using zero-profile anchored spacers versus standard interposition grafts with anterior plating. Materials and Methods This was a retrospective case series. A total of 53 male and 51 female consecutive patients (164 total operated levels) who underwent ACDF between 2007 and 2011 were included. The mean clinical follow-up was 15.7 ± 1.2 months (SEM) for patient with zero-profile implants and 14.8 ± 2.1 months for patients with conventional ACDF with anterior plating. Patient demographics, operative details, clinical outcomes, complications, and radiographic imaging were reviewed. Dysphagia was determined using Bazaz criteria. Results Clinical outcome scores were similar between the two groups as measured by the modified JOA and Nurick scores. Zero-profile constructs gave rise to significantly less prevertebral soft-tissue swelling compared with constructs with anterior plates postoperatively (15.74 ± 0.52 vs. 20.48 ± 0.85 mm, p < 0.001, respectively) and at the latest follow-up (10.88 ± 0.39 vs. 13.72 ± 0.67 mm, p < 0.001, respectively). At latest follow-up, there was a significantly lower incidence of dysphagia associated with utilization of zero-profile constructs as compared with anterior plate (1.5 vs. 20%, p = 0.001, respectively). Conclusion Zero-profile implants lead to functional outcomes similar to standard anterior plate constructs. Avoiding the use of anterior locking plate may decrease the risk of postoperative dysphagia.