Abstract
Purpose
To analyze the prospectively collected data in a series of patients treated with single- or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinico-radiological outcome, complications and technical hints, and to review the literature on such new devices.
Methods
Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2–4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis.
Results
SF-36 and NDI showed a statistically significant improvement (p < 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a “focal spondylectomy” was required.
Conclusion
The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.
Similar content being viewed by others
References
Agrillo U, Mastronardi L, Puzzilli F (2002) Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg 96(3 Suppl):273–276
Bagby GW (1995) Cages mètalliques intersomatiques filatèes pour arthrodesis rachidiennes. In: Duparc J, Schreiber A, Troisier O (eds) Instabilitès vertèbrales lombaires. Expansion Scientifique Francaise, Paris, pp 199–213
Barbagallo GM, Corbino LA, Papavero L, Fritzsche E, Albanese V (2009) Anatomic midline marking during cervical arthroplasty with ProDisc-C: an alternative, simple, and reliable method: technical note. J Spinal Disord Tech 22(8):610–614. doi:10.1097/BSD.0b013e31819b0a6f
Barbagallo GM, Assietti R, Corbino L, Olindo G, Foti PV, Russo V, Albanese V (2009) Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques? Eur Spine J 18(Suppl 1):29–39. doi:10.1007/s00586-009-0978-9
Bazaz R Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 27:2453-2458
Bohler J, Gaudernak T (1980) Anterior plate stabilization for fracture-dislocation of the lower cervical spine. J Trauma 20:203–205
Epstein NE (2012) Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: pros, cons, and costs. Surg Neurol Int 3(Suppl 3):S143–S156. doi:10.4103/2152-7806.98575
Fernyhough JC, White JI, LaRocca H (1991) Fusion rates in multilevel cervical spondylosis comparing allofraft fibula with autograft fibula in 126 patients. Spine 16:561–565
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr (2007) Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32:2310–2317
Fraser JF, Härtl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6(4):298–303
Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, Le Roux PD (2002) Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 15(5):362–368
Friedlaender GE, Huo M (1991) Bone graft and bone substitutes. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, New York, pp 565–754
Hofstetter C, Kesavabhotla K, Boockvar JA (2013) Zero-Profile anchored spacer reduces rate of dysphagia compared to ACDF with anterior plating. J Spinal Disord Tech. [Epub ahead of print]
Hwang SL, Lin CL, Lieu AS, Lee KS, Kuo TH, Hwang YF, Su YF, Howng SL (2004) Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation. J Neurosurg Spine 1(2):160–167
Jacobs W, Willems PC, Kruyt M, van Limbeek J, Anderson PG, Pavlov P, Bartels R, Oner C (2011) Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976) 36(14):E950–E960. doi:10.1097/BRS.0b013e31821cbba5
Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–236
Kasimatis GB, Panagiotopoulos E, Gliatis J, Tyllianakis M, Zouboulis P, Lambiris E (2009) Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg 111:18–27
Kim SW, Limson MA, Kim SB, Arbatin JJ, Chang KY, Park MS, Shin JH, Ju YS (2009) Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218–231
Korinth MC (2008) Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir 69:113–124
Lee MJ, Bazaz R, Furey CG, Yoo J (2005) Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 18(5):406–409
Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Technique for anterior cervical decompression for radiculopathy. J. Neurosurg Spine 11(2):183–197
Miao J, Shen Y, Kuang Y, Yang L, Wang X, Chen Y, Chen D (2012) Early follow-up outcomes of a new zero-profile implant used in anterior cervical discectomy and fusion. J Spinal Disord Tech. [Epub ahead of print]
Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 11(2):130–141
Muthukumar N (2012) Surgical management of cervical spondylotic myelopathy. Neurol India 60(2):201–209. doi:10.4103/0028-3886.96402
Niu CC, Liao JC, Chen WJ, Chen LH (2010) Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 23(5):310–316. doi:10.1097/BSD.0b013e3181af3a84
Park JB, Cho YS, Riew KD (2005) Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am 87:558–563
Peolsson A (2007) Investigation of clinically important benefit of anterior cervical decompression and fusion. Eur Spine J 16(4):507–514
Pitzen TR, Chrobok J, Stulik J, Ruffing S, Drumm J, Sova L, Kucera R, Vyskocil T, Steudel WI (2009) Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two year result of a multicentric, randomized, controlled study. Spine (Phila Pa 1976) 34(7):641–646
Riley LH 3rd, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG (2005) Dysphagia after anterior cervical decompression and fusion. Spine 30(22):2564–2569
Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DKJ, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Techniques for cervical interbody grafting. J Neurosurg Spine 11(2):203–220
Sahjpaul RL (2007) Esophageal perforation from anterior cervical screw migration. Surg Neurol 68(2):205–209
Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976) 28:140–142
Scholz M, Reyes PM, Schleicher P, Sawa AG, Baek S, Kandziora F, Marciano FF, Crawford NR (2009) A new stand-alone cervical anterior interbody fusion device. Spine 34(2):156–160
Scholz M, Schnake KJ, **el A, Hoffmann R, Kandziora F (2011) A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 469:666–673
Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP (2009) The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34:2886-2892
Thalgott JS, Fritts K, Giuffre JM, Timlin M (1999) Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299
Tortolani PJ, Cunningham BW, Vigna F, Hu N, Zorn CM, McAfee PC (2006) A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech 19:312–317
Vaccaro AR, Falatyn SP, Scuderi GJ, Eismont FJ, McGuire RA, Singh K, Garfin SR (1998) Early failure of a long segment anterior cervical plate fixation. J Spinal Disord 11:410–415
Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A (2002) A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiological study. Spine 27:1694–1701
Yang JY, Song HS, Lee M, Bohlman HH, Riew KD (2009) Adjacent level ossification development after anterior cervical fusion without plate fixation. Spine (Phila Pa 1976). 34(1):30-33
Wm Yue, Brodner W, Highland TR (2005) Persistent swallowing and voice problems after anterior cervical discectomy and fusion with allograft and plating: a 5 to 11 year follow-up study. Eur Spine J 14:677–682
Acknowledgments
The authors declare that no funding has been or will be received from any grant-giving organization in conjunction with the generation of this manuscript.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Barbagallo, G.M.V., Romano, D., Certo, F. et al. Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices. Eur Spine J 22 (Suppl 6), 868–878 (2013). https://doi.org/10.1007/s00586-013-3005-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-3005-0