ABSTRACT
BACKGROUND: Anterior cervical discectomy and fusion is a classic surgical procedure for the treatment of cervical spondylosis. At present, we can use a Zero-P interbody fusion fixture and a traditional cervical anterior plate plus cage as an internal fixation material. The Zero-P has less postoperative esophageal interference and lower incidence of postoperative dysphagia compared with traditional anterior cervical plate fixation. Besides, the Zero-P could avoid the risk of excessively long or pooriy placed plate injury to adjacent segmental intervertebral discs. OBJECTIVE: To compare the safety and effectiveness between two-level anterior cervical discectomy and fusion using Zero-P and using traditional anterior cervical plate plus cage. METHODS: Clinical data of sixty patients who underwent two-level anterior cervical discectomy and fusion in the Chengdu Third People’s Hospital from May 2016 to May 2018 were retrospectively analyzed. The patients were divided into Zero-P group (Zero-P fusion, n=30) and plate group (anterior cervical plate fixation combined with cage implantation, n=30). All patients in the two groups had informed consent to the treatment plan. This study was approved by the hospital ethics committee. The Japanese orthopedic association score, neck disability index score and Bazaz swallowing function score were used to evaluate the clinical efficacy. Cervical X-ray and cervical CT scans were performed to assess cervical curvature, observe bone graft fusion, and implant displacement, loosening and breakage. RESULTS AND CONCLUSION: (1) All surgeries were successfully completed in 60 patients. The wounds healed in stage I after operation. There were no serious complications such as nerve injury, esophageal fistula, and cerebrospinal fluid leakage. (2) During the follow-up, there was no significant difference in neck disability index, Japanese orthopedic association score and bone graft fusion rates between the two groups (P > 0.05). (3) The incidence and severity of dysphagia in the Zero-P group were lower than those in the plate group at various time points after operation (all P < 0.05). (4) The overall curvature and operative segments curvature were better in the plate group than in the Zero-P group 6 months after surgery and in final follow-up (P < 0.05). (5) Two-level anterior cervical discectomy and fusion using Zero-P is a safe and effective operative method. The operation time, bleeding volume, number of fluoroscopy and postoperative dysphagia incidence were better than the traditional anterior cervical plate plus cage fixation system, but it is not as good as the traditional anterior cervical plate plus cage system in the curvature of the cervical spine. Zero-P is not recommended for patients with obvious abnormal cervical curvature before operation.
ABSTRACT
Objective To explore the relationship among the prevertebral soft tissue swelling and dysphagia rate after anterior cervical diskectomy and fusion(ACDF),and to investigate the prevertebral soft tissue swelling and dysphagia rate after Zero-p or traditionaI cage and titanium plate for one-level lesion of cervical myelopathy.Methods The clinical data of 54 patients with one-level lesion (C5/6) of cervical myelopathy who undelwent anterior cenrical discectomy and fusion by Zero-p (n =25) or traditional cage and titanium plate (n =29) were analyzed.The postoperative prevertebral soft tissue swelling was measured by lateral radiographs.Patients were divided into the swelling group (n =24) and the non-swelling group(n =30) based on the degree of prevertebral soft tissue swelling and the incidences of dysphagia were analyzed.Patients were divided into the Zero-p group (n =25)and the Cage group (n =29) based on surgical treatment,the postoperative prevertebral soft tissue swelling and dysphagia rate were compared.Results The rate of dysphagia in swelling group was 45.8％,which was higher than 13.3％ in non-swelling group,the difference was significant(P ＜0.05).The postoperative prevertebral soft tissue swelling was 6.22 mm averagely after Zreo-p,which was less than that after traditional cage and titanium plate for anterior cervical discectomy with fusion(9.25 mm),the difference was significant (P ＜ 0.05).The incidence of dysphagia in Zero-p group was 12％,which was lower than 41.4％ in Cage group,and the difference was statistically significant (P ＜ 0.05).Conclusion It is a clinical significance to evaluate the degree of prevertebral soft tissue swelling by cervical lateral X-ray after ACDF,when the degree of prevertebral soft tissue swelling is greater,the incidence of complications such as dysphagia is higher.In addition,The Zero-p for the treatment of single one-level lesion of cervical myelopathy(C5/6) has a lower degree of prevertebral soft tissue swelling and dysphagia rate than the traditional Cage and titanium plate fusion.
ABSTRACT
STUDY DESIGN: Retrospective analysis. OBJECTIVES: To analyze the usefulness of Zero-P® by analyzing the radiological and clinical outcomes with a minimum of 2 years of follow-up. SUMMARY OF LITERATURE REVIEW: Anterior discectomy and fusion (ACDF) using Zero-P® showed excellent results. However, there is a lack of studies focusing on long-term outcomes. MATERIALS AND METHODS: Ninety-eight patients who underwent single-level ACDF using Zero-P® with more than 2 years of follow-up were included for analysis. In the radiological analysis, we evaluated disc height, segmental lordosis, and subsidence in the preoperative, postoperative, and last follow-up periods. The Neck Disability Index (NDI), Neck Visual Analogue Scale (VAS), and Arm VAS were also evaluated for clinical assessment. Radiological bony fusion was assessed, and radiological and clinical differences according to bony fusion were evaluated. RESULTS: Intervertebral disc height had increased 2.92 mm after surgery and subsided to 2.36 mm at the final follow-up. Subsidence of the screw was 0.58 mm at final follow-up. Segmental lordosis was 3.97° at the preoperative assessment, 8.39° in the postoperative follow-up, and 5.83° in the last follow-up. The Neck VAS score was 4.47, 2.28, and 1.27, respectively. The Arm VAS score was 5.73, 3.13, and 2.18; and NDI score was 17.8, 11.7, and 7.89, respectively. There was no association between the radiological and clinical results. Radiological nonunion was found in 18 subjects. There were no significant differences in radiological and clinical parameters according to bony union. CONCLUSIONS: ACDF with Zero-P® for treatment of degenerative cervical disease showed subsidence in 55.1% and nonunion in 18% of cases. However, the radiological results were not related to the clinical results.