Jun Dong1, Meng Lu1, Teng Lu1, Baobao Liang2, Junkui Xu3, Jun Zhou4, Hongjun Lv5, Jie Qin1, Xuan Cai1, Sihua Huang1, Haopeng Li1, Dong Wang1, Xijing He1. 1. Department of Orthopaedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710004, China. 2. Department of Plastic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710004, China. 3. Department of Orthopaedics, Xi'an Honghui hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710054, China. 4. Department of Dermatology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710004, China. 5. Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province 710061, China.
Abstract
BACKGROUND: Anterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results. METHODOLOGY: A meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques. RESULTS: Ten studies enrolling 719 cervical spondylosis patients were included. The pooled data showed significant differences in the operation time [SMD = -0.58 (95% CI = -0.77 to 0.40, p < 0.01)] and blood loss [SMD = -0.40, 95% CI (-0.59 to -0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia. CONCLUSIONS: Compared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.
BACKGROUND: Anterior plate fusion is an effective procedure for the treatment of cervical spinal diseases but is accompanied by a high incidence of postoperative dysphagia. A zero profile (Zero-P) spacer is increasingly being used to reduce postoperative dysphagia and other potential complications associated with surgical intervention. Studies comparing the Zero-P spacer and anterior plate have reported conflicting results. METHODOLOGY: A meta-analysis was conducted to compare the safety, efficacy, radiological outcomes and complications associated with the use of a Zero-P spacer versus an anterior plate in anterior cervical spine fusion for the treatment of cervical spinal disease. We comprehensively searched PubMed, Embase, the Cochrane Library and other databases and performed a meta-analysis of all randomized controlled trials (RCTs) and prospective or retrospective comparative studies assessing the two techniques. RESULTS: Ten studies enrolling 719 cervical spondylosispatients were included. The pooled data showed significant differences in the operation time [SMD = -0.58 (95% CI = -0.77 to 0.40, p < 0.01)] and blood loss [SMD = -0.40, 95% CI (-0.59 to -0.21), p < 0.01] between the two groups. Compared to the anterior plate group, the Zero-P group exhibited a significantly improved JOA score and reduced NDI and VAS. However, anterior plate fusion had greater postoperative segmental and cervical Cobb's angles than the Zero-P group at the last follow-up. The fusion rate in the two groups was similar. More importantly, the Zero-P group had a lower incidence of earlier and later postoperative dysphagia. CONCLUSIONS: Compared to anterior plate fusion, Zero-P is a safer and effective procedure, with a similar fusion rate and lower incidence of earlier and later postoperative dysphagia. However, the results of this meta-analysis should be accepted with caution due to the limitations of the study. Further evaluation and large-sample RCTs are required to confirm and update the results of this study.
Authors: Jeffrey A Rihn; Justin Kane; Todd J Albert; Alexander R Vaccaro; Alan S Hilibrand Journal: Clin Orthop Relat Res Date: 2011-03 Impact factor: 4.176
Authors: Mithun Nambiar; Kevin Phan; John Edward Cunningham; Yi Yang; Peter Lawrence Turner; Ralph Mobbs Journal: Eur Spine J Date: 2017-03-10 Impact factor: 3.134
Authors: Julian L Gendreau; Lily H Kim; Payton N Prins; Marissa D'Souza; Paymon Rezaii; Arjun V Pendharkar; Eric S Sussman; Allen L Ho; Atman M Desai Journal: Global Spine J Date: 2019-11-21
Authors: Mostafa A Gabr; Elisabeth Touko; Amol P Yadav; Isaac Karikari; C Rory Goodwin; Michael W Groff; Luis Ramirez; Muhammad M Abd-El-Barr Journal: Global Spine J Date: 2019-12-26
Authors: Nicolas Lonjon; Emmanuel Favreul; Jean Huppert; Eric Lioret; Manuel Delhaye; Ramzi Mraidi Journal: Medicine (Baltimore) Date: 2019-01 Impact factor: 1.817
Authors: Roberto Alfonso De Leo-Vargas; Ildefonso Muñoz-Romero; Michel Gustavo Mondragón-Soto; Jaime Jesús Martínez-Anda Journal: Asian Spine J Date: 2019-04-10