Cervical anterior Zero-P fusion system versus cage fusion system combined with titanium plate for the treatment of cervical spondylosis: a Meta-analysis

English Keywords:Cervical spondylosis  Anterior cervical discectomy and fusion  Zero-profile device  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To compare the efficacy and safety of two different intervertebral fusion in the surgical treatment of cervical spondylosis. Methods: Literatures for the surgical treatment of cervical spondylosis by using the Zero-P intervertebral fusion system and cage intervertebral fusion system combined with titanium plate between January 2008 and June 2018 were collected from the databases(PubMed, Embase, Cochrane Library, CNKI). Literatures were selected according to inclusion and exclusion criteria and evaluated by Newcastle Ottawa scale (NOS). The extracted data included operation time, intraoperative blood loss, postoperative dysphagia, cervical Japanese Orthopaedic Association(JOA) score, neck disability index(NDI) score, visual analogue score(VAS), Cobb angle, fusion rate and incidence of adjacent segment degeneration after surgery. Meta analysis was performed by using the software Revman 5.3, and data were pooled by using a fixed effect model or a random effect model to calculate the odds ratio(OR)/standardized mean difference(SMD)/risk difference(RD) and 95% confidence interval(CI). Publication bias was determined by the funnel plot. Results: A total of 1159 patients (Zero-P 546 patients, cage fusion 613 patients) from 14 literatures was included in the study. Six literatures scored 9 points, four scored 8 points and four scored 7 points in the literatures quality evaluation. Meta-analysis showed that operation time, intraoperative blood loss, incidence of postoperative dysphagia and chronic dysphagia of the intervertebral fusion system with Zero-P were significantly lower than those of cage intervertebral fusion system combined with titanium plate. There was no significant difference in cervical JOA score, DNI, VAS score, Cobb angle, fusion rate or incidence of adjacent segment degeneration after surgery between two devices. Funnel plot showed no obvious publication bias. Conclusions： Compared with intervertebral fusion system combined with titanium plate, cervical anterior Zero-P fusion shows a more satisfactory effect in the treatment of cervical spondylosis. Cervical anterior Zero-P fusion is also safer for its reduction of operation time, intraoperative blood loss and postoperative dysphagia.