title: Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study: Clinical article.
abstract: OBJECTIVE
  Anterior cervical plating decreases the risk of pseudarthrosis following anterior cervical discectomy and fusion (ACDF). Dysphagia is a common complication of ACDF, with the anterior plate implicated as a potential contributor. A zero-profile, stand-alone polyetheretherketone (PEEK) interbody spacer has been postulated to minimize soft-tissue irritation and postoperative dysphagia, but studies are limited. The object of the present study was to determine the clinical and radiological outcomes for patients who underwent ACDF using a zero-profile integrated plate and spacer device, with a focus on the course of postoperative prevertebral soft-tissue thickness and the incidence of dysphagia.
  
  
  METHODS
  Using a surgical database, the authors conducted a retrospective analysis of all patients who had undergone ACDF between August 2008 and October 2011. All patients received a Zero-P implant (DePuy Synthes Spine). The Neck Disability Index (NDI) and visual analog scale (VAS) scores for arm and neck pain were documented. Dysphagia was determined using the Bazaz criteria. Prevertebral soft-tissue thickness, spinal alignment, and subsidence were assessed as well.
  
  
  RESULTS
  Twenty-two male and 19 female consecutive patients, with a mean age of 58.4 ± 14.68, underwent ACDF (66 total operated levels) in the defined study period. The mean clinical follow-up in 36 patients was 18.6 ± 9.93 months. Radiological outcome in 37 patients was assessed at a mean follow-up of 9.76 months (range 7.2-19.7 months). There were significant improvements in neck and arm VAS scores and the NDI following surgery. The neck VAS score improved from a median of 6 (range 0-10) to 0 (range 0-8; p < 0.001). The arm VAS score improved from a median of 2 (range 0-10) to 0 (range 0-7; p = 0.006). Immediate postoperative dysphagia was experienced by 58.4% of all patients. Complete resolution was demonstrated in 87.8% of affected patients at the latest follow-up. The overall median Bazaz score decreased from 1 (range 0-3) immediately postoperatively to 0 (range 0-2; p < 0.001) at the latest follow-up. Prevertebral soft-tissue thickness significantly decreased across all levels from a mean of 15.8 ± 4.38 mm to 10.1 ± 2.93 mm. Postoperative lordosis was maintained at the latest follow-up. Mean subsidence from the immediate postoperative to the latest follow-up was 4.1 ± 4.7 mm (p < 0.001). Radiographic fusion was achieved in 92.6% of implants. No correlation was found between prevertebral soft-tissue thickness and Bazaz dysphagia score.
  
  
  CONCLUSIONS
  A zero-profile integrated plate and spacer device for ACDF surgery produces clinical and radiological outcomes that are comparable to those for nonintegrated plate and spacer constructs. Chronic dysphagia rates are comparable to or better than those for previously published case series.
authors.affiliation: Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College; and.
authors.forename: Innocent
authors.initials: I
authors.lastname: Njoku
authors.forename: Marjan
authors.initials: M
authors.lastname: Alimi
authors.forename: Lewis Z
authors.initials: LZ
authors.lastname: Leng
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Shin
authors.forename: Andrew R
authors.initials: AR
authors.lastname: James
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhangoo
authors.forename: Apostolos John
authors.initials: AJ
authors.lastname: Tsiouris
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm; D001577:Benzophenones; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000601:surgery*; D003680:Deglutition Disorders / Q000453:epidemiology / Q000517:prevention & control; D004185:Disability Evaluation; D017586:Diskectomy / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007659:Ketones; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000601:surgery; D010147:Pain Measurement; D011092:Polyethylene Glycols; D011108:Polymers; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D019736:Prostheses and Implants; D011474:Prosthesis Design; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*; D016896:Treatment Outcome
chemical_list: D001577:Benzophenones; D007659:Ketones; D011108:Polymers; C063834:polyetheretherketone; D011092:Polyethylene Glycols
keywords: ACDF = anterior cervical discectomy and fusion; BMI = body mass index; NDI = Neck Disability Index; PEEK = polyetheretherketone; VAS = visual analog scale; anterior cervical discectomy and fusion; chronic dysphagia; prevertebral soft-tissue thickness