Abstract
Objective The current study aimed to explore the efficacy of Zero profile intervertebral fusion system (Zero-P) and traditional anterior plate cage system (PC) in the treatment of cervical spondylotic myelopathy (CSM). Further, the present study evaluated effects of the treatments on medical security, height of intervertebral disc, adjacent-level ossification development (ALOD), and adjacent segmentation disease (ASD) through a systematic retrospective analysis. Methods Studies on Zero-P system and traditional anterior plate cage system for ACDF in the treatment of CSM were searched in PubMed, Web of Science, Ovid, Embase, and Cochrane Library databases. Two independent researchers screened articles, extracted data, and evaluated the quality of the articles based on the inclusion and exclusion criteria of the current study. RevMan5.3 software was used for meta-analysis following the guidelines of Cochrane collaboration network. Cervical curvature, interbody fusion rate, preoperative and postoperative disc height index (DHI), fusion cage sinking rate, postoperative dysphagia, ASD, ALOD, and loosening of screw were compared between the two groups. Results A total of 17 literatures were included in the present study, including 6 randomized controlled trials and 11 observational studies. The studies comprised a total of 1204 patients with CSM, including 605 patients in the Zero-P system group (Zero-P group) and 599 patients in the traditional animal plate cage group (PC group). Results of this meta-analysis showed that postoperative dysphagia [OR = 0.40, CI (0.28, 95% 0.58), P < 0.00001], ALOD [OR = 0.09, CI (0.02, 95% 0.39), P = 0.001], ASD [OR = 0.42, CI (0.20, 95% 0.86), P = 0.02], and screw loosening [OR = 0.20, CI (0.08, 95% 0.52), P = 0.0009] of the Zero-P group were significantly lower compared with the PC group. On the other hand, preoperative cervical curvature [WMD = −0.23, CI (−1.38, 95% 0.92), P = 0.69], postoperative cervical curvature [WMD = −0.38, CI (−1.77, 95% 1.01), P = 0.59], cage sinking rate [OR = 1.41, CI [0.52, 95% 3.82], P = 0.50], intervertebral fusion rate [OR = 0.76, CI (0.27, 95% 2.48), P = 0.38], preoperative DHI [WMD = −0.04, CI (−0.14, 95% 0.22), P = 0.65], and postoperative DHI [WMD = 0.06, CI (−0.22, 95% 0.34), P = 0.675] were not significantly different between the two groups. Conclusion It was evident that the Zero-P system used in ACDF is superior compared with the traditional anterior plate cage system in postoperative dysphagia, avoiding ALOD, ASD, and screw loosening.
Highlights
Incidence of degenerative diseases is annually increasing due to the increase in the number of elderly population.erefore, previous studies have shown an increase in the incidence of cervical spondylotic myelopathy (CSM) which is a common cause of spinal cord dysfunction
Erefore, previous studies have shown an increase in the incidence of cervical spondylotic myelopathy (CSM) which is a common cause of spinal cord dysfunction
Clinical studies on efficacy of treatment degenerative cervical spondylosis were selected using the following keywords and phrases: “Zero profile intervertebral fusion system (Zero-P),” “Zero Profile,” “anterior cervical discectomy and fusion,” and “ACDF” as search terms. e keywords were searched independently and all synonyms as well as variants of the keywords were searched by combining free words and subject words concurrently
Summary
Erefore, previous studies have shown an increase in the incidence of cervical spondylotic myelopathy (CSM) which is a common cause of spinal cord dysfunction. Several studies have explored methods for effective alleviation of spinal cord compression in patients with CSM and restoration of the spinal cord function. When conservative methods are ineffective or in the case of worsening symptoms, active surgical treatment is recommended for patients with CSM to release nerve compression for timely restoration of normal spinal cord function [1, 2]. Anterior cervical surgery was first reported as a safe and effective method for treatment of the degenerative cervical spondylosis by Cloard, Smith, and Robinson in 1958. Anterior cervical discectomy and fusion (ACDF) is conventionally fixed with anterior interbody fusion cage and steel plate. Anterior cervical discectomy and fusion (ACDF) is conventionally fixed with anterior interbody fusion cage and steel plate. is fixing system has several advantages but is associated with potential disadvantages. e most common shortcomings of these techniques include fracture or loosening of plates and screws, tracheal-esophageal interference and influence, and difficulties in postoperative swallowing [6, 7]
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