Abstract:Objective To evaluate the clinical outcomes and complications of ACDF with Zero-P and cages with plate in treating multiple-level cervical spondylosis (MCS) with cervical kyphosis.Methods Clinical data of patients with MCS caused by degenerative disc herniation were retrospectively analyzedfrom August 2012 to March 2016.Clinical parameters including Japanese orthopedic association (JOA)score,neck disabled index(NDI) and visual analogue scale(VAS) were evaluated.The orthopaedic effect of Zero-P and cages with plate were investigated according to changes of the cervical Cobb angle and intervertebral space height.Results All patients were followed up for an average of 24.7 months in Group A and 25.2 months in Group B.45 cases of patients’ main symptoms were significantly reduced.There was no serious complications.Postoperative symptoms improved with time.The JOA score,the VAS score,the NDI index,the cervical intervertebral height and the Cobb angle one month after operation and during last follow-up were improved significantly compared with the preoperative data.The differences were statistically significant(P<0.05) in Group A and Group B.But the differences between Group A and Group B were not statistically significant(P>0.05).Conclusion Based on the follow-up,Anterior cervical decompression and fusion with Zero-P and cages with plate could achieve good effect in treating multilevel cervical spondylotic myelopathy with kyphosis.
[1]Ghogawala Z,Coumans JV,Benzel EC,et al.Ventral versus dorsal decompression for cervical spondylotic myelopathy:surgeons' assessment of eligibility for randomization in a proposed randomized controlled trial:results of a survey of the cervical spine research society[J].Spine,2007,32(4):429-436.
[2]Konya D,Ozgen S,Gercek A,et al.Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy[J].J Clin Neurosci,2009,16(3):404-409.
[3]Hillard VH,Apfelbaum RI.Surgical management of cervical myelopathy:indications and techniques for multilevel cervical discectomy[J]Spine J,2006,6(Suppl 6):242-251.
[4]Chang SW,Kakarla UK,Maughan PH,et al.Four-level anterior cervical discectomy and fusion with plate fixation:radiographic and clinical results[J].Neurosurgery,2010,66(4):639-647.
[5]Fraser JF,Hartl R.Anterior approaches to fusion of the cervical spine:a meta analysis of fusion rates[J].J Neurosurg Spine,2007,6(4):298-303.
[6]Scholz M,Schnake KJ,Pingel A,et al.A new Zero-Profile implant for stand-alone anterior cervical interbody fusion[J].Clin Orthop Relat Res,2011(469):666-673.
[7]Barbagallo GMV,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[J].Eur Spine J,2013,22(6):868-878.
[8]Yu Chen,Huajiang Chen.Comparative analysis of clinical outcomes between Zero-Profile implant and cages with plate fixation in treating multilevel cervicalspondilotic myelopathy:A three-year follow-up[J].Clin Neurol Neurosurg,2016(144):72-76.
[9]Liu T,Xu W,Cheng T,et al.Anterior versus posterior surgery for multilevel cervical myelopathy,which one is better? A systematic review[J].Eur Spine J,2011,20 (2):224-235.
[10]Rafael Dela GR,Risheng Xu,Seba Ramhmdani,et al.Erratum:Long-term clinical outcomes following 3-and 4-level anterior cervical discectomy and fusion[J].J Neurosurg Spine,2016,24(6):1-7.
[11]Park JB,Cho YS,Riew KD.Development of adjacent-level ossification inpatients with an anterior cervical plate[J].J Bone Joint Surg(Am),2005,87(3):558-563.
[12]Fountas KN,Kapsalaki EZ,Nikolakakos LG,et al.Anterior cervical discectomy and fusion associated complications[J].Spine,2007,32(21):2310-2317.
[13]Lee MJ,Bazaz R,Furey CG,et al.Influence of anterior cervical plate design on dysphagia:a 2-year prospective longitudinal follow-up study[J].J Spinal Disord Tech,2005,18(5):406-409.
[14]Fogel GR,McDonnell MF.Surgical treatment of dysphagia after anterior cervical interbody fusion[J].Spine J,2005,5(2):140-144.
[15]Cho HJ,Hur JW,Lee JB,et al.Cervical stand-alone polyetheretherketone cage versus Zero-Profile anchored spacer in single-levelanterior cervical discectomy and fusion:minimum 2-year assessment of radiographic and clinical outcome[J].J Korean Neurosurg Soc,2015,58(2):119-124.
[16]Njoku I Jr,Alimi M,Leng LZ,et al.Anterior cervical discectomy andfusion with a Zero-Profile integrated plate andspacer device:a clinical and radiological study:clinical article[J].J Neurosurg Spine,2014,21(4):529-537.
[17]Chong E,Pelletier MH,Mobbs RJ,et al.The design evolution of interbody cages in anterior cervical discectomy and fusion:a systematic review[J].BMC Musculoskelet Disord,2015(16):99-109.
[18]Yang H,Chen D,Wang X,et al.Zero-Profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system[J].Arch Orthop Trauma Surg,2015,135(6):781-787.
[19]Joaquim AF,Murar J,Savage JW,et al.Dysphagia after anterior cervical spine surgery:a systematic review of potential preventative measures[J].Spine J,2014,14(9):2246-2260.
[20]Elsawaf A,Mastronardi L,Roperto R,et al.Effect of cervical dynamics on adjacent segment degeneration after anterior cervical fusion with cages[J].Neurosurg Rev,2009,32(2):215-224.
[21]Finn MA,Bradke DS,Daubs M,et al.Local and global subaxial cervical spine biomechanics after sin gle-level fusion or cervical arthroplasty[J].Eur Spine J,2009,18(10):1520-1527.
[22]Park MS,Kelly MP,Lee DH,et al.Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis[J].Spine J,2014,14(7):1228-1234.