Use of stand-alone anchored intervertebral cage in the surgical treatment of patients with symptomatic cervical spondylosis
One of the most common surgical operations for treatment of cervical spondylosis is anterior cervical discectomy with fusion (ACDF). In order to achieve stable fusion after discectomy and avoid dysphagia the artificial stand-alone zero-profile cages with integrated screws were developed and introduced into clinical practice. Outcome and complications after ACDF with such cages were not adequately assessed yet.
We analyzed 20 consecutive patients with cervical spondylosis treated in our institution with ACDF with stand-alone zero-profile cage Zero-P. Before and after surgery and then 6, 12 and 24 months after surgery we assessed the level of pain with VAS scale, severity of myelopathy with mJOA scale and dysphagia with four level scale. Treatment outcome was assessed after 2 years according to Odom's criteria.
No complications occurred during surgery or recovery after surgery. The VAS score after surgery and then after 6, 12 and 24 months was statistically significantly lower than before surgery (p<0.05). The mJOA scores were 6, 12 and 24 months after surgery statistically significantly higher than before surgery (p<0.05). Transient and mild dysphagia was present after surgery in 15% (3/20) of patients and 6, 12 or 24 months after surgery in none. Outcome after 2 years was excellent in 9 patients and good in 11 patients.
Operative treatment of symptomatic cervical spondylosis with ACDF using stand-alone zero-profile cage with integrated screws is safe and efficient. Incidence of dysphagia after surgery is low and generally transient.
Adams CB, Logue V. Studies in cervical spondylotic myelopathy. II. The movement and contour of the spine in relation to the neural complications of cervical spondylosis. Brain 1971; 94: 568-86.
Law MD Jr, Bernhardt M, White AA 3rd. Evaluation and management of cervical spondylotic myelopathy. Instr Course Lec 1995; 44: 99-110.
Okada E, Matsumoto M, Ichihara D, Chiba K, Toyama Y, Fujiwara H, et al. Aging of the cervical spine in healthy volunteers: a 10-year longitudinal magnetic resonance imaging study. Spine (Phila Pa 1976) 2009; 34: 706-12.
Matz PG, Holly LT, Mummaneni PV, Anderson PA, Groff MW, Heary RF, et al. Anterior cervical surgery for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 2009; 11: 170-3.
Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, et al. Techniques for anterior cervical decompression for radiculopathy. J Neurosurg Spine 2009; 11: 183-97.
Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 2009; 11: 130-41.
Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958; 15: 602-17.
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: 607-24.
Heary RF, Schlenk RP, Sacchieri TA, Barone D, Brotea C. Persistent iliac crest donor site pain: independent outcome assessment. Neurosurgery 2002; 50: 510-7.
Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A. A prospective randomized comparison between the cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiologic study. Spine (Phila Pa 1976) 2002; 27: 1694-701.
Siddiqui AA, Jackowski A. Cage versus tricortical graft for cervical interbody fusion. A prospective randomised study. J Bone Joint Surg Br 2003; 85: 1019-25.
Silber JS, Anderson DG, Daffner SD, Brislin BT, Leland JM, Hilibrand AS, et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine (Phila Pa 1976) 2003; 28: 134-9.
Schils F, Rilliet B, Payer M. Implantation of an empty carbon fiber cage or a tricortical iliac crest autograft after cervical discectomy for single-level disc herniation: a prospective comparative study. J Neurosurg Spine 2006; 4: 292-9.
Bärlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 2002; 12: E4.
Kwon B, Kim DH, Marvin A, Jenis LG. Outcomes following anterior cervical discectomy and fusion: the role of interbody disc height, angulation, and spinous process distance. J Spinal Disord Tech 2005; 18: 304-8.
Sahjpaul RL. Esophageal perforation from anterior cervical screw migration. Surg Neurol 2007; 68: 205-10.
Cagli S, Isik HS, Zileli M. Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg 2009; 19: 437-40.
Riley LH 3rd, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976) 2005; 30: 2564-9.
Yue WM, Brodner W, Highland TR. 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 2005; 14: 677-82.
Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 2007; 32: 2310-7.
Park JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am 2005; 87: 558-63.
Yang JY, Song HS, Lee M, Bohlman HH, Riew KD. Adjacent level ossification development after anterior cervical fusion without plate fixation. Spine (Phila Pa 1976) 2009; 34: 30-3.
Shono Y, McAfee PC, Cunningham BW, Brantigan JW. A biomechanical analysis of decompression and reconstruction methods in the cervical spine. Emphasis on a carbon-fiber-composite cage. J Bone Joint Surg Am 1993; 75: 1674-84.
Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F. A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 2011; 469: 666-73.
Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 2002; 27: 2453-8.
Chiles BW 3rd, Leonard MA, Choudhri HF, Cooper PR. Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery 1999; 44: 762-70.
Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc 1958; 166: 23-8.
Azab W, Abdel-Razek M, Ali A, Abdelrahman A, Salaheldin W, Nasim K, et al. Outcome evaluation of a zero-profile implant for anterior cervical diskectomy with fusion. Turk Neurosurg 2012; 22: 611-7.
Miao J, Shen Y, Kuang Y, Yang L, Wang X, Chen Y, et al. Early follow-up outcomes of a new zero-profile implant used in anterior cervical discectomy and fusion. J Spinal Disord Tech 2013; 26: E193-7.
Yang L, Gu Y, Liang L, Gao R, Shi S, Shi J, et al. Stand-alone anchored spacer versus anterior plate for multilevel anterior cervical diskectomy and fusion. Orthopedics 2012; 35: e1503-10.
Barbagallo GM, Romano D, Certo F, Milone P, Albanese V. 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. V tisku 2013.
Hofstetter CC, Kesavabhotla K, Boockvar JA. Zero-profile Anchored Spacer Reduces Rate of Dysphagia Compared to ACDF With Anterior Plating. J Spinal Disord Tech. V tisku 2013.
Qi M, Chen H, Liu Y, Zhang Y, Liang L, Yuan W. The use of a zero-profile device compared with an anterior plate and cage in the treatment of patients with symptomatic cervical spondylosis: A preliminary clinical investigation. Bone Joint J 2013; 95-B: 543-7.
Vanek P, Bradac O, Delacy P, Lacman J, Benes V. 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: E792-7.
Peolsson A, Vavruch L, Hedlund R. Long-term randomised comparison between a carbon fibre cage and the Cloward procedure in the cervical spine. Eur Spine J 2007; 16: 173-8.
Kaiser MG, Mummaneni PV, Matz PG, Anderson PA, Groff MW, Heary RF, et al. Management of anterior cervical pseudarthrosis. J Neurosurg Spine 2009; 11: 228-37.
Böhler J, Gaudernak T. Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma 1980; 20: 203-5.
Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 2009; 34: 2886-92.
Scholz M, Reyes PM, Schleicher P, Sawa AG, Baek S, Kandziora F, et al. A new stand-alone cervical anterior interbody fusion device: biomechanical comparison with established anterior cervical fixation devices. Spine (Phila Pa 1976) 2009; 34: 156-60.
Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV. Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976) 2003; 28: 140-2.
Vaccaro AR, Falatyn SP, Scuderi GJ, Eismont FJ, McGuire RA, Singh K, et al. Early failure of long segment anterior cervical plate fixation. J Spinal Disord 1998; 11: 410-5.
Smith-Hammond CA, New KC, Pietrobon R, Curtis DJ, Scharver CH, Turner DA. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976) 2004; 29: 1441-6.
Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 2005; 18: 406-9.
Tortolani PJ, Cunningham BW, Vigna F, Hu N, Zorn CM, McAfee PC. A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech 2006; 19: 312-7.