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. 2025 May 16:17:213-220.
doi: 10.2147/ORR.S517491. eCollection 2025.

Contiguous Two-Level Anterior Cervical Discectomy and Fusion Using Zero-P VA System: A Retrospective Study

Qiang Zhang  1 , Zhe Chen  1 , Yazhou Lin  1 , Peng Cao  1 , Xingkai Zhang  1 , Wenjian Wu #  1 , Yu Liang #  1
Affiliations

Contiguous Two-Level Anterior Cervical Discectomy and Fusion Using Zero-P VA System: A Retrospective Study

Qiang Zhang et al. Orthop Res Rev. .

Abstract

Purpose: The aim of this study was to explore short-term radiological findings after contiguous two-level ACDF with Zero-P VA devices.

Methods: Patients who underwent contiguous two-level anterior cervical discectomy and fusion (ACDF) from C3 to C7 with a Zero-P VA system were followed. Cervical anteroposterior and lateral X-rays and functional outcomes were assessed 3 months after surgery.

Results: Overall, 34.9% of patients had prosthesis subsidence and 74.6% screw loosening. Up to 46.8% of the patients with screw loosening also experienced prosthesis subsidence compared with 0 patients without screw loosening (p=0.0005). The screw-loosening rate was 91.7% in patients with poor positioning of the screw/cage and 70.6% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (p=0.267). The subsidence rate was 50% in patients with poor positioning of the screw/cage and 31.4% in patients without poor positioning of the screw/cage, but no statistical difference was found between the groups (p=0.314). VAS scores of patients with prosthesis subsidence were much higher than those without (p=0.031), but this difference was not found for patients with or without screw loosening (p=0.116). The NDI scale was much higher in patients regradless of screw loosening or subsidence.

Conclusion: Screw loosening and prosthesis subsidence happen frequently after contiguous two-level ACDF with Zero-P VA. Screw loosening seems to be the only risk factor for prosthesis subsidence.

Keywords: Zero-P VA; contiguous two-level ACDF; prosthesis subsidence; screw loosening.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Having failed with 7 months of conservative treatment, a 76-year-old man suffering from C5–C6 and C6–C7 degenerative cervical spondylosis was treated with C5–C7 ACDF with the Zero-P VA system. The X-ray after 12 weeks demonstrated loosening of the C5–C6 downward screw (“double halo” sign, black arrow). Prosthesis subsidence did not occur in C5–C6, but did in C6–C7 without screw loosening (white arrow).
Figure 2
Figure 2
Having failed with 6 months of conservative treatment, a 62-year-old woman suffering from C4–C5 and C5–C6 degenerative cervical spondylosis was treated with C4–C6 ACDF with three Zero-P VA system. The X-ray after 12 weeks demonstrated loosening of the C5–C6 upward screw (black arrow) and prosthesis subsidence in C5–C6 (white arrow).
See this image and copyright information in PMC

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