Anterior Cervical Discectomy and Fusion—Can a Standalone Zero-Profile Titanium Cage a Better Alternative Option to Traditional Cervical Plate-Titanium Cage Combination?: A Prospective Observational Study

Abstract

Abstract Introduction  Anterior cervical plating in anterior cervical discectomy and fusion (ACDF) has inherent drawbacks like plate loosening, screw pullout, breakage, trachea-esophageal irritation and fistula, increased operation time, and increased duration of hospital stay. Due to low profile and in-built screw fixation slots, Zero-profile (Zero-P) cages are becoming popular among spine surgeons since they are supposed to minimize drawbacks that are associated with anterior cervical plates. Aims  In our study, we evaluated two different fixation methods: (1) anterior cervical plate plus titanium cage and (2) zero-P titanium cages with respect to duration of surgery, length of hospitalization, rate of fusion, and postoperative complications. Materials and Methods  This was a comparative prospective observational study with a sample size of 30 patients. Patients with cervical compressive disease (radiculopathy/myelopathy or combined symptoms) who require ACDF and fit in inclusion criteria were divided in two groups: group A—anterior cervical plate and titanium cage and group B—Zero-P titanium. Statistical Analysis Used  Mann–Whitney U test was used for the duration of stay, and Student's t -test was used for the duration of surgery. Results  C4–5 level was most commonly involved followed by C5–C6 level and C3–C4 level. The mean duration of surgery in group A was 141.3 minutes and group B was 111.3 minutes. The mean duration of stay in group A was 4.40 days and group B was 2.0 days. Two patients in group A and one patient in group B had dysphagia. One each in both groups had developed hoarseness of voice after surgery. Two patients in group A and one in group B had persistent donor site pain till 6 weeks to 2 months. One patient each of both groups had cage subsidence. Almost all patients in both groups achieved fusion by 6 months. Conclusion  ACDF with standalone Zero-P cage is equally good. Duration of surgery and duration of stay were shorter in standalone Zero-P cage group. We feel it is good for patients and healthcare since it reduces overall financial burden.