A Meta-analysis of Zero-profile versus cage-plate interbody fusion system in anterior cervical discectomy and fusion for the treatment of multilevel cervical spondylosis

English Keywords:Zero-profile  Cage-plate  ACDF  Multilevel cervical spondylotic  Meta-analysis

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy, radiological results and complications of zero-profile (Zero-p) and cage-plate interbody fusion in multilevel cervical spondylosis by meta-analysis. Methods: An extensive computer search was conducted in the database of CNKI, Wanfang, CBMdisc, PubMed, Ovid and Medline for relevant articles, with search terms of Zero-p, Zero-profile, ROI-C, cage and plate, stand-alone anchored spacer, anchored cage, anchored spacer, no-profile, and ACDF. The articles were evaluated according to the inclusion and exclusion criteria. Screening literatures, data extraction and quality assessment were conducted by two reviewers independently. Meta-analysis was conducted by using RevMan 5.3 software. Results: 8 high quality articles were eventually included into this study according to the criteria, totaling 634 patients with 302 cases in Zero-p group and 332 in cage-plate group. Meta-analysis showed there were no significant differences in JOA scores[MD=-0.14, 95% CI(-0.36, 0.09), P=0.23], NDI scores[MD=-0.05, 95% CI(-0.43, 0.33), P=0.80] and surgical level fusion rate[RR=0.99, 95% CI(0.95, 1.04), P=0.78] between the two groups. Compared with cage-plate group, Zero-p group had shorter operation time[MD=-13.08, 95% CI (-23.38, -2.78), P=0.01], less intraoperative blood loss[MD=-6.76, 95% CI(-12.92, -0.61), P=0.03], smaller C2-7 Cobb angle[MD=-3.11, 95% CI(-4.47, -1.74), P＜0.0001], thinner prevertebral soft tissue[MD=-1.00, 95% CI(-1.35, -0.65), P＜0.00001], lower incidence of dysphagia[RR=0.61, 95% CI(0.50, 0.75), P＜0.00001], lower incidence of adjacent segment degeneration[RR=0.20, 95% CI(0.06, 0.66), P=0.008] and higher subsidence rate[RR=3.07, 95% CI(1.73, 5.47), P=0.0001] in multilevel surgery. Conclusions: Both Zero-p and the cage-plate fixation have similar clinical efficacy in the treatment of multilevel cervical spondylosis. Zero-p fusion has advantages of shorter operation time, less intraoperative blood loss, lower incidence of dysphagia and adjacent segment degeneration, while traditional cage-plate fixation is better at restoring cervical curvature and preventing cage subsidence.