Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis

Abstract

Background: In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy.

Methods: A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings.

Results: Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups.

Conclusion: In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.

Keywords: Anterior cervical decompression and fusion; Cage plate; Meta-analysis; Single level; Zero-profile.

Fig. 1

Flow diagram of study selection

Fig. 2

Forest plot of operation time (SD, standard deviation; IV, inverse-variance method; CI, confidence interval; df, degree of freedom)

Fig. 3

Forest plot of intraoperative blood loss

Fig. 4

Forest plot of the postoperative JOA score

Fig. 5

Forest plot of postoperative NDI scores

Fig. 6

Forest plot of surgical segmental fusion rate

Fig. 7

Forest plot of postoperative height of adjacent vertebrae

Fig. 8

Forest plot of postoperative settlement rate

Fig. 9

Postoperativel coronal and sagittal cervical X-ray with Zero-P or Cage-plate surgery. 1A, 1B Postoperative cervical X-ray with Zero-p surgery. 1C, 1D X-ray at postoperative 1 month with Zero-p surgery. 2A, 2B Postoperative cervical X-ray with Cage-plate surgery. 2C, 2D X-ray at postoperative 1 month with Cage-plate surgery

Fig. 10

Comparison of incidence of dysphagia

Fig. 11

Comparison of the postoperative adjacent disc degeneration rate