A comparison of clinical efficacies of contiguous 2-level anterior cervical discectomy and fusion using zero-profile and cage-and-plate fixation in treating cervical spondylosis

English Keywords:Cervical spondylosis  Anterior cervical discectomy and fusion  2-level  Zero-profile  Cage-and-plate  Intermediate vertebral body collapse

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of zero-profile(ZP) and cage-and-plate(CP) fixation in two contiguous levels of anterior cervical discectomy and fusion(ACDF). Methods: 57 patients with cervical spondylosis treated with 4-pin ZP or CP fixation in contiguous 2-level ACDF between March 1, 2018 and June 30, 2021 in the First Clinical Medical College of Guangzhou University of Chinese Medicine were retrospectively analyzed. Of all the patients, 27 were fixed with ZP(ZP group), including 12 males and 15 females, aged 37-80(53.0±9.9) years; and the other 30 were fixed with CP(CP group), including 10 males and 20 females, aged 39-78(57.4±12.4) years. The body mass index(BMI), L1-4 bone mineral density(BMD), preoperative and postoperative 1, 3, 6 and 12 months, and final follow-up neck disability index(NDI), Japanese Orthopaedic Association(JOA) score, and axial pain visual analogue scale(VAS), and preoperative and postoperative 3d, and 1, 3, 6 and 12 months, and final follow-up cervical curvature, surgical segment curvature, and final follow-up interbody fusion rate and adjacent level degeneration rate, and intermediate vertebral collapse and other postoperative complications during follow-up were collected and compared between the two groups. Results: No significant differences were observed in the baseline data such as age, gender, BMI, L1-4 BMD, follow-up period, preoperative NDI and JOA score, preoperative cervical curvature and surgical segment curvature between the two groups(P>0.05). Postoperative NDI, JOA score, and axial pain VAS score were improved over time in both groups(P＜0.001). There was no statistical difference between the two groups in JOA score at the same time point(P=0.314). At 3 and 6 months, and 1 year and the final follow-up, the improvement of NDI and axial pain VAS scores in the CP group was significantly better than that in the ZP group(P<0.05). At the final follow-up, cervical curvature loss and surgical level curvature loss in the ZP group were significantly greater than those in the CP group(P<0.05), and there were no significant differences in the incidence of interbody fusion rate and adjacent level degeneration rate between the two groups. During the whole follow-up process, there were 4 cases of intermediate vertebral collapse in the ZP group, but none in the CP group, with statistical difference between the two groups(P<0.05). Conclusions: In 2-level ACDF, compared with ZP fixation, the application of CP can better maintain the curvature of cervical spine, avoid intermediate vertebral collapse, and obtain better clinical efficacy.