Sohail Amir; Shahid Ayub

doi:10.19080/OAJNN.2024.19.556008

Research Article

Anterior Cervical Discectomy and Fusion Surgery: Results with Zero-Profile Spacer/Cage

Sohail Amir* and Shahid Ayub

Assistant Professor Neurosurgery, Department of Neurosurgery, Hayatabad Medical Complex, MTI, Peshawar, Pakistan

Submission: March 25, 2024; Published: September 27, 2024

*Corresponding author: Sohail Amir, Assistant Professor Neurosurgery, Department of Neurosurgery, Hayatabad Medical Complex, MTI, Peshawar, Pakistan, Email: dr.sohailamir@gmail.com

How to cite this article: Sohail Amir* and Shahid Ayub. Anterior Cervical Discectomy and Fusion Surgery: Results with Zero-Profile Spacer/Cage. Open Access J Neurol Neurosurg 2024; 19(2): 556008. DOI: 10.19080/OAJNN.2024.19.556008.

Abstract

Objective: This study will give a proof to support the benefit of applying zero-profile cage in anterior cervical discectomy and fusion surgery in a single level.

Material and Methods: A retrospective study of 26 patients with cervical disc disease treated with a zero-profile cage was designed and followed up for an average of 12 months in descriptive research. For arm and neck pain, the Neck Disability Index (NDI) and Visual analogue scale (VAS) scores were used to assess function. Nurick’s myelopathy classification scheme based on gait impairments was also documented.

Results: The average age of the 26 patients was 48.96 13.13 years (mean SD), with 44 percent of the patients falling into the 40–60-year age bracket. The male/female gender distribution was 21 (84%) 4 (16%) male/female. Radiculomyelopathic symptoms were detected in 11 (28%) of the patients, with radicular pain occurring bilaterally in seven (28%) of the patients and on the left side in four (16%). At six months and one year, a radiological examination of fusion was performed. The fusion had a success rate of 95 percent at six months (19 patients) and 100 percent at one year.

Conclusion: A zero-profile device provides biomechanical stability and fusion rates with excellent outcomes for one- and two-level ACDFs. Advantages include low rates of dysphagia, decreased operative time, restoration of cervical lordosis and disc height, and lack of cage subsidence or screw back out.

Keywords: Anterior Cervical Discectomy and Fusion (ACDF); Zero-Profile Cages; Cervical Spondylotic Myelopathy

Introduction

Anterior cervical discectomy and fusion (ACDF) was first introduced by Smith and Robinson and has been used since then as the main surgical treatment for single- to multilevel cervical degenerative disc disease (CDDD) [1]. CDDD and cervical spondylotic myelopathy) are major causes of arm pain with or without neurologic deficits [2,3].

Surgery may be considered if nonoperative treatment fails. In patients with cervical disc degenerative disorders, anterior cervical discectomy and fusion (ACDF) has been frequently used since the 1950s [4]. The treatment involves decompression of neural tissue, which is accomplished by removing disc material and then rebuilding and stabilizing the spinal column at one or more cervical vertebral levels [5,6]. The anchoring cage or stand-alone cage is another name for the zero-profile implant [7]. A cage and an internal implant with a pair of locking screws make up the device [8,9]. It enables the internal implant to be put directly into intervertebral disc tissue, with the screws for fixation being introduced into the surrounding vertebral body.

Anterior cervical plates and intervertebral cages were also used during this time. Many surgeons use an anterior plate during fusion surgeries to improve stabilization since multiple studies have shown that it results to higher fusion rates and reduced failure rates [10]. Plate-related complications, such as postoperative dysphagia, tracheoesophageal lesions, and plate displacement, have, however, become a growing source of worry. When compared to the plate and cage system, the zero-profile implant (Zero-P) was recently invented and widely used for one or two segmental ACDF surgeries [11]. It was discovered that the Zero-P implant could achieve similar clinical results and significantly reduced the incidence of dysphagia and adjacent segment degeneration [12,13].

Thus, the purposes of this study were to retrospectively evaluate the clinical and radiological outcomes of ACDF treatments for cervical disc degenerative disease (CDDD) using Zero Profile cage. and also note down the complication rate associated with this type of surgery.

Material and Methods

Study Setting and Design: The research was carried out at the Hayatabad Medical Complex in Peshawar, Pakistan. Between February 2018 and December March 2021. A retrospective study of 26 patients with cervical disc disease treated with a zero-profile cage was designed and followed up for an average of 12 months in descriptive research.

For arm and neck pain, the Neck Disability Index (NDI) and Visual analogue scale (VAS) scores were used to assess function. Nurick’s myelopathy classification scheme based on gait impairments was also documented. Plain X-rays and, when indicated, a CT scan were used to confirm radiological fusion at 12 months.

Inclusion Criteria

All male and female patients between the ages of 18 and 70 who underwent ACDF Procedure for single level with a zeroprofile spacer/cage were included in this study.

Exclusion Criteria

All those subjects having previous cervical surgeries severe cervical kyphosis, ossified posterior longitudinal ligaments and acute spinal cord injury were excluded from the study.

Results

The average age of the 26 patients was 48.96 13.13 years (mean SD), with 44 percent of the patients falling into the 40-60-year age bracket. The male/female gender distribution was 21 (84%) 4 (16%) male/female. There were 20 (80%) single-level affections and five (20%) double-level affections, with disc C5/6 and disc C6/7 being implicated ten times (33.33%) each. The average operational time was 110 minutes (42 minutes), with an average blood loss of 89 cc (45 cc). The most common interbody cage size implanted was 6 mm, with 15 mm screws being the most common screw length. In 11 (44%) of the patients, the neuropathology was found at both the cord and the root (radiculomyelopathy), while in 14 (56%) of the patients, the neuropathology was found just at the root level.

Radiculomyelopathic symptoms were detected in 11 (28%) of the patients, with radicular pain occurring bilaterally in seven (28%) of the patients and on the left side in four (16%). At six months and one year, a radiological examination of fusion was performed. The fusion had a success rate of 95 percent at six months (19 patients) and 100 percent at one year.

When the pre-operative and post-operative VAS pain levels for the neck and upper limb were compared after 12 months, there was a statistically significant improvement (p 0.001). When comparing pre-operative and post-operative scores at 12 months, the Nurick Score indicated a statistically significant improvement (p 0.002). In our study the most common complication was dysphagia, followed by adjacent level ossification development. Adjacent segment disease was observed. no case of sinking cage or screw loosening was observed in our study.

Discussion

ACDF has been frequently utilized for the treatment of cervical degenerative disc degeneration since it was first developed by Smith Robinson and Cloward in 1958 [14]. To achieve intervertebral fusion, autologous bone transplant was initially used. However, the use of a bone graft may cause difficulties at the donor site, such as hematoma formation, neurological damage, infection, and discomfort. Later on, a variety of implants and devices to aid intervertebral fusion were created. The plate and cage system, out of all the devices, can provide robust stability and enhance cervical sagittal alignment, and is still extensively used today because of these benefits. However, it has been observed that this method has a higher risk of problems such as dysphagia and adjacent segment degeneration (ASD), which are not insignificant. Thus zero-profile implant system (Zero-P, for example) was created to reduce the occurrence of dysphagia and ASDs [15,16].

In our study the pre-operative and post-operative VAS pain levels for the neck and upper limb were compared after 12 months, there was a statistically significant improvement (p 0.001). When comparing pre-operative and post-operative scores at 12 months, the Nurick Score indicated a statistically significant improvement (p 0.002). E.A. El Baz et al. shows the similar results [13].

In our study the most common complication was dysphagia, followed by adjacent level ossification development. Adjacent segment disease was observed. no case of sinking cage or screw loosening was observed in our study. Similarly, Barbagallo GMV, Romano D, Certo F, Milone P, Albanese V (2013) 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 device [17]. in this study five patients (20%) reported dysphagia postoperatively, three cases (12%) of mild transient dysphagia resolved in two weeks, and two cases (8%) of moderate dysphagia resolved in five weeks both were two-level ACDFs [18].

Conclusion

A zero-profile device provides biomechanical stability and fusion rates with excellent outcomes for one- and two-level ACDFs. Advantages include low rates of dysphagia, decreased operative time, restoration of cervical lordosis and disc height, and lack of cage subsidence or screw back out.