Introduction: Interposition grafts combined with anterior plating currently remain the gold standard for anterior cervical discetomy and fusion. The use of anterior plates increases fusion rates, but may be associated with higher rates of postoperative dysphagia. The goal of the current study was to determine the clinical and radiological outcomes following anterior cervical discectomy and fusion (ACDF) using zero-profile anchored spacers versus standard interposition grafts with anterior plating.
Methods: In a retrospective cohort study, A total of 53 male and 51 female consecutive patients (164 total operated levels) who underwent ACDF between 2007 and 2011 were included in the current study. The mean clinical follow-up was 15.7 ± 1.2 (SEM) months for patient with zero-profile implants and 14.8 ± 2.1 months for patients with conventional ACDF with anterior plating. Patient demographics, operative details, clinical outcome, complications and radiographic imaging were reviewed. Dysphagia was determined using Bazaz criteria.
Results: Clinical outcome scores were similar between both groups as measured by the modified JOA and Nurick scores. Zero-profile constructs gave rise to significantly less prevertebral soft tissue swelling compared to constructs with anterior plates postoperatively (15.74 ± 0.52 as compared to 20.48 ± 0.85 mm, p < 0.001) and at the time of last follow-up (10.88 ± 0.39 mm vs. 13.72 ± 0.67 mm, p < 0.001). There was a significant difference in the incidence of dysphagia at latest follow-up between cohorts as well (1.5% vs. 20%, p=0.001, zero-profile vs. anterior plate respectively).
Conclusions: Zero-profile implants lead to functional outcomes similar to standard anterior plate constructs. Omission of an anterior locking plate may decrease the risk of postoperative dysphagia. Further studies are required to delineate the pathophysiological mechanisms underlying postoperative dysphagia after ACDF.
Patient Care: Proper selection of interbody device for ACDF, reasulting in lower side effects
Learning Objectives: To learn about dysphagia associated with different interbody devices used in ACDF