Skip to main content

Advertisement

Log in

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

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To analyze the prospectively collected data in a series of patients treated with single- or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinico-radiological outcome, complications and technical hints, and to review the literature on such new devices.

Methods

Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2–4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis.

Results

SF-36 and NDI showed a statistically significant improvement (p < 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a “focal spondylectomy” was required.

Conclusion

The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Agrillo U, Mastronardi L, Puzzilli F (2002) Anterior cervical fusion with carbon fiber cage containing coralline hydroxyapatite: preliminary observations in 45 consecutive cases of soft-disc herniation. J Neurosurg 96(3 Suppl):273–276

    PubMed  CAS  Google Scholar 

  2. Bagby GW (1995) Cages mètalliques intersomatiques filatèes pour arthrodesis rachidiennes. In: Duparc J, Schreiber A, Troisier O (eds) Instabilitès vertèbrales lombaires. Expansion Scientifique Francaise, Paris, pp 199–213

    Google Scholar 

  3. Barbagallo GM, Corbino LA, Papavero L, Fritzsche E, Albanese V (2009) Anatomic midline marking during cervical arthroplasty with ProDisc-C: an alternative, simple, and reliable method: technical note. J Spinal Disord Tech 22(8):610–614. doi:10.1097/BSD.0b013e31819b0a6f

    Article  PubMed  Google Scholar 

  4. Barbagallo GM, Assietti R, Corbino L, Olindo G, Foti PV, Russo V, Albanese V (2009) Early results and review of the literature of a novel hybrid surgical technique combining cervical arthrodesis and disc arthroplasty for treating multilevel degenerative disc disease: opposite or complementary techniques? Eur Spine J 18(Suppl 1):29–39. doi:10.1007/s00586-009-0978-9

    Article  PubMed  Google Scholar 

  5. Bazaz R Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976) 27:2453-2458

    Google Scholar 

  6. Bohler J, Gaudernak T (1980) Anterior plate stabilization for fracture-dislocation of the lower cervical spine. J Trauma 20:203–205

    Article  PubMed  CAS  Google Scholar 

  7. Epstein NE (2012) Iliac crest autograft versus alternative constructs for anterior cervical spine surgery: pros, cons, and costs. Surg Neurol Int 3(Suppl 3):S143–S156. doi:10.4103/2152-7806.98575

    Article  PubMed  Google Scholar 

  8. Fernyhough JC, White JI, LaRocca H (1991) Fusion rates in multilevel cervical spondylosis comparing allofraft fibula with autograft fibula in 126 patients. Spine 16:561–565

    Article  Google Scholar 

  9. Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr (2007) Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32:2310–2317

    Article  Google Scholar 

  10. Fraser JF, Härtl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6(4):298–303

    Article  PubMed  Google Scholar 

  11. Frempong-Boadu A, Houten JK, Osborn B, Opulencia J, Kells L, Guida DD, Le Roux PD (2002) Swallowing and speech dysfunction in patients undergoing anterior cervical discectomy and fusion: a prospective, objective preoperative and postoperative assessment. J Spinal Disord Tech 15(5):362–368

    Article  PubMed  Google Scholar 

  12. Friedlaender GE, Huo M (1991) Bone graft and bone substitutes. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven, New York, pp 565–754

    Google Scholar 

  13. Hofstetter C, Kesavabhotla K, Boockvar JA (2013) Zero-Profile anchored spacer reduces rate of dysphagia compared to ACDF with anterior plating. J Spinal Disord Tech. [Epub ahead of print]

  14. Hwang SL, Lin CL, Lieu AS, Lee KS, Kuo TH, Hwang YF, Su YF, Howng SL (2004) Three-level and four-level anterior cervical discectomies and titanium cage-augmented fusion with and without plate fixation. J Neurosurg Spine 1(2):160–167

    Article  PubMed  Google Scholar 

  15. Jacobs W, Willems PC, Kruyt M, van Limbeek J, Anderson PG, Pavlov P, Bartels R, Oner C (2011) Systematic review of anterior interbody fusion techniques for single- and double-level cervical degenerative disc disease. Spine (Phila Pa 1976) 36(14):E950–E960. doi:10.1097/BRS.0b013e31821cbba5

    Article  Google Scholar 

  16. Kaiser MG, Haid RW Jr, Subach BR, Barnes B, Rodts GE Jr (2002) Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 50:229–236

    PubMed  Google Scholar 

  17. Kasimatis GB, Panagiotopoulos E, Gliatis J, Tyllianakis M, Zouboulis P, Lambiris E (2009) Complications of anterior surgery in cervical spine trauma: an overview. Clin Neurol Neurosurg 111:18–27

    Article  PubMed  CAS  Google Scholar 

  18. Kim SW, Limson MA, Kim SB, Arbatin JJ, Chang KY, Park MS, Shin JH, Ju YS (2009) Comparison of radiographic changes after ACDF versus Bryan disc arthroplasty in single and bi-level cases. Eur Spine J 18:218–231

    Article  PubMed  Google Scholar 

  19. Korinth MC (2008) Treatment of cervical degenerative disc disease: current status and trends. Zentralbl Neurochir 69:113–124

    Article  PubMed  CAS  Google Scholar 

  20. Lee MJ, Bazaz R, Furey CG, Yoo J (2005) Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech 18(5):406–409

    Article  PubMed  Google Scholar 

  21. Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Technique for anterior cervical decompression for radiculopathy. J. Neurosurg Spine 11(2):183–197

    Article  PubMed  Google Scholar 

  22. Miao J, Shen Y, Kuang Y, Yang L, Wang X, Chen Y, Chen D (2012) Early follow-up outcomes of a new zero-profile implant used in anterior cervical discectomy and fusion. J Spinal Disord Tech. [Epub ahead of print]

  23. Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 11(2):130–141

    Article  PubMed  Google Scholar 

  24. Muthukumar N (2012) Surgical management of cervical spondylotic myelopathy. Neurol India 60(2):201–209. doi:10.4103/0028-3886.96402

    Article  PubMed  CAS  Google Scholar 

  25. Niu CC, Liao JC, Chen WJ, Chen LH (2010) Outcomes of interbody fusion cages used in 1 and 2-levels anterior cervical discectomy and fusion: titanium cages versus polyetheretherketone (PEEK) cages. J Spinal Disord Tech 23(5):310–316. doi:10.1097/BSD.0b013e3181af3a84

    Article  PubMed  Google Scholar 

  26. Park JB, Cho YS, Riew KD (2005) Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am 87:558–563

    Article  PubMed  Google Scholar 

  27. Peolsson A (2007) Investigation of clinically important benefit of anterior cervical decompression and fusion. Eur Spine J 16(4):507–514

    Article  PubMed  Google Scholar 

  28. Pitzen TR, Chrobok J, Stulik J, Ruffing S, Drumm J, Sova L, Kucera R, Vyskocil T, Steudel WI (2009) Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two year result of a multicentric, randomized, controlled study. Spine (Phila Pa 1976) 34(7):641–646

    Article  Google Scholar 

  29. Riley LH 3rd, Skolasky RL, Albert TJ, Vaccaro AR, Heller JG (2005) Dysphagia after anterior cervical decompression and fusion. Spine 30(22):2564–2569

    Article  PubMed  Google Scholar 

  30. Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DKJ, Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons and Congress of Neurological Surgeons (2009) Techniques for cervical interbody grafting. J Neurosurg Spine 11(2):203–220

    Article  PubMed  Google Scholar 

  31. Sahjpaul RL (2007) Esophageal perforation from anterior cervical screw migration. Surg Neurol 68(2):205–209

    Article  PubMed  Google Scholar 

  32. Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976) 28:140–142

    Article  Google Scholar 

  33. Scholz M, Reyes PM, Schleicher P, Sawa AG, Baek S, Kandziora F, Marciano FF, Crawford NR (2009) A new stand-alone cervical anterior interbody fusion device. Spine 34(2):156–160

    Article  PubMed  Google Scholar 

  34. Scholz M, Schnake KJ, Pingel A, Hoffmann R, Kandziora F (2011) A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res 469:666–673

    Article  PubMed  CAS  Google Scholar 

  35. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP (2009) The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34:2886-2892

    Google Scholar 

  36. Thalgott JS, Fritts K, Giuffre JM, Timlin M (1999) Anterior interbody fusion of the cervical spine with coralline hydroxyapatite. Spine 24:1295–1299

    Article  PubMed  CAS  Google Scholar 

  37. Tortolani PJ, Cunningham BW, Vigna F, Hu N, Zorn CM, McAfee PC (2006) A comparison of retraction pressure during anterior cervical plate surgery and cervical disc replacement: a cadaveric study. J Spinal Disord Tech 19:312–317

    Article  PubMed  Google Scholar 

  38. Vaccaro AR, Falatyn SP, Scuderi GJ, Eismont FJ, McGuire RA, Singh K, Garfin SR (1998) Early failure of a long segment anterior cervical plate fixation. J Spinal Disord 11:410–415

    PubMed  CAS  Google Scholar 

  39. Vavruch L, Hedlund R, Javid D, Leszniewski W, Shalabi A (2002) A prospective randomized comparison between the Cloward procedure and a carbon fiber cage in the cervical spine: a clinical and radiological study. Spine 27:1694–1701

    Article  PubMed  Google Scholar 

  40. Yang JY, Song HS, Lee M, Bohlman HH, Riew KD (2009) Adjacent level ossification development after anterior cervical fusion without plate fixation. Spine (Phila Pa 1976). 34(1):30-33

    Google Scholar 

  41. Wm Yue, Brodner W, Highland TR (2005) 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 14:677–682

    Article  Google Scholar 

Download references

Acknowledgments

The authors declare that no funding has been or will be received from any grant-giving organization in conjunction with the generation of this manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giuseppe M. V. Barbagallo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barbagallo, G.M.V., 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. Eur Spine J 22 (Suppl 6), 868–878 (2013). https://doi.org/10.1007/s00586-013-3005-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-3005-0

Keywords

Navigation