Effect of zero-profile and self-locking intervertebral cage and plate-cage construct on maintenance of cervical curvature after anterior cervical surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Junsong ,  LIU Peng , LIU Tuanjiang , LIU Jijun , CHEN Hao , XU Xiaozhou , ZHANG Jianan , ZHANG Zhengping ,  HAO Dingjun

Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

LIU Peng, Email: 13991814651@163.com; HAO Dingjun, Email: haodingjun@126.com

Keywords：

Single-segment cervical spondylosis; anterior cervical discectomy and fusion; zero-profile and self-locking intervertebral cage; plate-cage construct; cervical curvature

DOI：

10.7507/1002-1892.201904097

Video：

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Objective To compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct (PCC).Methods A clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016. Among them, 50 patients were treated with the zero-profile and self-locking intervertebral cage (group A) and 50 patients with the PCC (group B). There was no significant difference between the two groups in age, gender, bone mineral density, disease duration, operative segment, and preoperative visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, C_2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height (P>0.05). The operation time and intraoperative blood loss were recorded. The postoperative VAS and JOA scores were used to evaluate the clinical efficacy. The C_2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height were measured on lateral X-ray films, and the interbody fusion was evaluated according to Pitzen’s criteria.Results The operation time in group A was significantly shorter than that in group B (t=2.442, P=0.021), but there was no significant difference in the intraoperative blood loss between the two groups (t=0.812, P=0.403). All patients were followed up 24-36 months, with an average of 28.5 months. According to Pitzen’s criteria for cervical interbody fusion, bone fusion achieved in both groups. The VAS score, JOA score, C_2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation (P<0.05). The C_2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of group A at 24 months changed significantly compared with those at 1 month (P<0.05). The other indexes of the two groups showed no significant difference between the different time points after operation (P>0.05). There were significant differences in C_2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height between the two groups at 24 months after operation (P<0.05); but there was no significant difference in the clinical indexes at 1 and 24 months and the imaging indexes at 1 month between the two groups (P>0.05).Conclusion Compared with the PCC, the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy, but the intervertebral height loss and secondary cervical curvature change after operation is more serious.

Citation： YANG Junsong, LIU Peng, LIU Tuanjiang, LIU Jijun, CHEN Hao, XU Xiaozhou, ZHANG Jianan, ZHANG Zhengping, HAO Dingjun. Effect of zero-profile and self-locking intervertebral cage and plate-cage construct on maintenance of cervical curvature after anterior cervical surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 151-156. doi: 10.7507/1002-1892.201904097 Copy

1.	Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist, 2013, 19(4): 409-421.
2.	Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
3.	Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976), 2009, 34(26): 2886-2892.
4.	Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976), 2009, 34(7): 641-646.
5.	Riley LH 3rd, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976), 2005, 30(22): 2564-2569.
6.	Lee MJ, Bazaz R, Furey CG, et al. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech, 2005, 18(5): 406-409.
7.	Li Y, Hao D, He B, et al. The efficiency of zero-profile implant in anterior cervical discectomy fusion: a prospective controlled long-term follow-up study. J Spinal Disord Tech, 2015, 28(10): 398-403.
8.	Yang H, Chen D, Wang X, et al. Zero-profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system. Arch Orthop Trauma Surg, 2015, 135(6): 781-787.
9.	Nemoto O, Kitada A, Naitou S, et al. Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up. Eur J Orthop Surg Traumatol, 2015, 25 (Suppl 1): S127-S134.
10.	Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am), 1958, 40-A(3): 607-624.
11.	Sevastikoglou JA, Bergquist E. Evaluation of the reliability of radiological methods for registration of scoliosis. Acta Orthop Scand, 1969, 40(5): 608-613.
12.	庄超, 周栋, 汤雪明, 等. 颈前路零切迹椎间融合内固定系统治疗脊髓型颈椎病的疗效分析. 中国修复重建外科杂志, 2015, 29(6): 751-755.
13.	郭龙, 范顺武. 零切迹颈前路椎间融合系统与颈前路钢板椎间融合系统临床疗效比较. 中国修复重建外科杂志, 2015, 29(7): 840-844.
14.	Vanek P, Bradac O, Delacy P, et al. Anterior interbody fusion of the cervical spine with Zero-P spacer: prospective comparative study-clinical and radiological results at a minimum 2 years after surgery. Spine (Phila Pa 1976), 2013, 38(13): E792-E797.
15.	Lee YS, Kim YB, Park SW. Does a zero-profile anchored cage offer additional stabilization as anterior cervical plate? Spine (Phila Pa 1976), 2015, 40(10): E563-570.
16.	王宁, 何百祥, 鲍刚, 等. 颈前路“零切迹”椎间融合器与传统钛板融合器内固定治疗单节段颈椎病的疗效比较. 西安交通大学学报 (医学版), 2016, 2(2): 174-177, 186.
17.	Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J, 2007, 16(9): 1395-1400.
18.	Kim CH, Chung CK, Jahng TA, et al. Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages. J Spinal Disord Tech, 2015, 28(1): E17-E24.
19.	Schmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine, 2006, 4(6): 447-453.
20.	Lee CH, Hyun SJ, Kim MJ, et al. Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech, 2013, 26(2): 112-118.
21.	Chen Y, Wang X, Lu X, et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J, 2013, 22(7): 1539-1546.
22.	朱迪, 李晨曦, 刘宝戈, 等. 零切迹自锁融合器治疗老年人多节段颈椎病中期临床疗效及影像学变化. 中华老年医学杂志, 2019, 38(2): 185-190.

1. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist, 2013, 19(4): 409-421.
2. Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976), 2005, 30(19): 2138-2144.
3. Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976), 2009, 34(26): 2886-2892.
4. Pitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976), 2009, 34(7): 641-646.
5. Riley LH 3rd, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976), 2005, 30(22): 2564-2569.
6. Lee MJ, Bazaz R, Furey CG, et al. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech, 2005, 18(5): 406-409.
7. Li Y, Hao D, He B, et al. The efficiency of zero-profile implant in anterior cervical discectomy fusion: a prospective controlled long-term follow-up study. J Spinal Disord Tech, 2015, 28(10): 398-403.
8. Yang H, Chen D, Wang X, et al. Zero-profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system. Arch Orthop Trauma Surg, 2015, 135(6): 781-787.
9. Nemoto O, Kitada A, Naitou S, et al. Stand-alone anchored cage versus cage with plating for single-level anterior cervical discectomy and fusion: a prospective, randomized, controlled study with a 2-year follow-up. Eur J Orthop Surg Traumatol, 2015, 25 (Suppl 1): S127-S134.
10. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am), 1958, 40-A(3): 607-624.
11. Sevastikoglou JA, Bergquist E. Evaluation of the reliability of radiological methods for registration of scoliosis. Acta Orthop Scand, 1969, 40(5): 608-613.
12. 庄超, 周栋, 汤雪明, 等. 颈前路零切迹椎间融合内固定系统治疗脊髓型颈椎病的疗效分析. 中国修复重建外科杂志, 2015, 29(6): 751-755.
13. 郭龙, 范顺武. 零切迹颈前路椎间融合系统与颈前路钢板椎间融合系统临床疗效比较. 中国修复重建外科杂志, 2015, 29(7): 840-844.
14. Vanek P, Bradac O, Delacy P, et al. Anterior interbody fusion of the cervical spine with Zero-P spacer: prospective comparative study-clinical and radiological results at a minimum 2 years after surgery. Spine (Phila Pa 1976), 2013, 38(13): E792-E797.
15. Lee YS, Kim YB, Park SW. Does a zero-profile anchored cage offer additional stabilization as anterior cervical plate? Spine (Phila Pa 1976), 2015, 40(10): E563-570.
16. 王宁, 何百祥, 鲍刚, 等. 颈前路“零切迹”椎间融合器与传统钛板融合器内固定治疗单节段颈椎病的疗效比较. 西安交通大学学报 (医学版), 2016, 2(2): 174-177, 186.
17. Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J, 2007, 16(9): 1395-1400.
18. Kim CH, Chung CK, Jahng TA, et al. Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages. J Spinal Disord Tech, 2015, 28(1): E17-E24.
19. Schmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine, 2006, 4(6): 447-453.
20. Lee CH, Hyun SJ, Kim MJ, et al. Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech, 2013, 26(2): 112-118.
21. Chen Y, Wang X, Lu X, et al. Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur Spine J, 2013, 22(7): 1539-1546.
22. 朱迪, 李晨曦, 刘宝戈, 等. 零切迹自锁融合器治疗老年人多节段颈椎病中期临床疗效及影像学变化. 中华老年医学杂志, 2019, 38(2): 185-190.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of zero-profile and self-locking intervertebral cage and plate-cage construct on maintenance of cervical curvature after anterior cervical surgery

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