ObjectiveTo compare differences in the maintenance of cervical curvature after anterior cervical surgery between zero-profile and self-locking intervertebral cage and plate-cage construct (PCC).MethodsA clinical data of 100 patients with single-segment cervical disc herniation who were treated with anterior cervical discectomy and fusion were retrospectively analyzed between January 2015 and January 2016. Among them, 50 patients were treated with the zero-profile and self-locking intervertebral cage (group A) and 50 patients with the PCC (group B). There was no significant difference between the two groups in age, gender, bone mineral density, disease duration, operative segment, and preoperative visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, C2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height (P>0.05). The operation time and intraoperative blood loss were recorded. The postoperative VAS and JOA scores were used to evaluate the clinical efficacy. The C2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height were measured on lateral X-ray films, and the interbody fusion was evaluated according to Pitzen’s criteria.ResultsThe operation time in group A was significantly shorter than that in group B (t=2.442, P=0.021), but there was no significant difference in the intraoperative blood loss between the two groups (t=0.812, P=0.403). All patients were followed up 24-36 months, with an average of 28.5 months. According to Pitzen’s criteria for cervical interbody fusion, bone fusion achieved in both groups. The VAS score, JOA score, C2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of the two groups at 1 and 24 months after operation were significantly improved when compared with those before operation (P<0.05). The C2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height of group A at 24 months changed significantly compared with those at 1 month (P<0.05). The other indexes of the two groups showed no significant difference between the different time points after operation (P>0.05). There were significant differences in C2-7 cervical curvature, segmental Cobb angle, and adjacent vertebral height between the two groups at 24 months after operation (P<0.05); but there was no significant difference in the clinical indexes at 1 and 24 months and the imaging indexes at 1 month between the two groups (P>0.05).ConclusionCompared with the PCC, the zero-profile and self-locking intervertebral cage can significantly shorten the operation time and obtain the same clinical efficacy, but the intervertebral height loss and secondary cervical curvature change after operation is more serious.
Objective To evaluate the safety and effectiveness of applying self-stabilizing zero-profile three-dimensional (3D) printed artificial vertebral bodies in anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy. Methods A retrospective analysis was conducted on 37 patients diagnosed with cervical spondylotic myelopathy who underwent single-level ACCF using either self-stabilizing zero-profile 3D-printed artificial vertebral bodies (n=15, treatment group) or conventional 3D-printed artificial vertebral bodies with titanium plates (n=22, control group) between January 2022 and February 2023. There was no significant difference in age, gender, lesion segment, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between the two groups (P>0.05). Operation time, intraoperative bleeding volume, hospitalization costs, JOA score and improvement rate, incidence of postoperative prosthesis subsidence, and interbody fusion were recorded and compared between the two groups. Results Compared with the control group, the treatment group had significantly shorter operation time and lower hospitalization costs (P<0.05); there was no significant difference in intraoperative bleeding volume between the two groups (P>0.05). All patients were followed up, with a follow-up period of 6-21 months in the treatment group (mean, 13.7 months) and 6-19 months in the control group (mean, 12.7 months). No dysphagia occurred in the treatment group, while 5 cases occurred in the control group, with a significant difference in the incidence of dysphagia between the two groups (P<0.05). At 12 months after operation, both groups showed improvement in JOA scores compared to preoperative scores, with significant differences (P<0.05); however, there was no significant difference in the JOA scores and improvement rate between the two groups (P>0.05). Radiographic examinations showed the interbody fusion in both groups, and the difference in the time of interbody fusion was not significant (P>0.05). At last follow-up, 2 cases in the treatment group and 3 cases in the control group experienced prosthesis subsidence, with no significant difference in the incidence of prosthesis subsidence (P>0.05). There was no implant displacement or plate-screw fracture during follow-up.Conclusion The use of self-stabilizing zero-profile 3D-printed artificial vertebral bodies in the treatment of cervical spondylotic myelopathy not only achieves similar effectiveness to 3D-printed artificial vertebral bodies, but also reduces operation time and the incidence of postoperative dysphagia.