Abstract：
OBJECTIVE: To compare the safety, clinical outcomes, and radiological results of anterior cervical discectomy and fusion (ACDF) with zero-profile anchored spacer (ZPAS) versus plate and cage (PC) for 3-level contiguous cervical degenerative disease.
METHODS: The study was registered at PROSPERO (CRD42024512706). The Web of Science core collection, PubMed, and Embase were searched up to February 12, 2024. Review Manager 5.3 was used. The relative risk (RR) and 95% confidence interval were evaluated for dichotomous data. Continuous data were assessed using the mean difference and 95% confidence interval.
RESULTS: Nine studies comparing ACDF with ZPAS versus PC for 3-level contiguous cervical degenerative disease were included. The intraoperative blood loss and operation time in ZPAS were significantly less than those in PC. The subsidence rate, loss of cervical alignment, fusion segmental height, and intervertebral disc height were significantly greater in ZPAS than in PC. The cervical alignment and dysphagia rate within 6 months were significantly lower in ZPAS than in PC. The ASD of ZPAS was significantly lower than that of PC according to the sensitivity analysis when 1 study was excluded. No significant differences were identified in the other aspects.
CONCLUSIONS: Both ACDF with ZPAS and PC were safe and effective procedures. PC was associated with increased surgical trauma. The ZPAS could better decrease the incidence of ASD and dysphagia. ZPAS was also accompanied by high subsidence rate and poor cervical alignment.
METHODS: The study was registered at PROSPERO (CRD42024512706). The Web of Science core collection, PubMed, and Embase were searched up to February 12, 2024. Review Manager 5.3 was used. The relative risk (RR) and 95% confidence interval were evaluated for dichotomous data. Continuous data were assessed using the mean difference and 95% confidence interval.
RESULTS: Nine studies comparing ACDF with ZPAS versus PC for 3-level contiguous cervical degenerative disease were included. The intraoperative blood loss and operation time in ZPAS were significantly less than those in PC. The subsidence rate, loss of cervical alignment, fusion segmental height, and intervertebral disc height were significantly greater in ZPAS than in PC. The cervical alignment and dysphagia rate within 6 months were significantly lower in ZPAS than in PC. The ASD of ZPAS was significantly lower than that of PC according to the sensitivity analysis when 1 study was excluded. No significant differences were identified in the other aspects.
CONCLUSIONS: Both ACDF with ZPAS and PC were safe and effective procedures. PC was associated with increased surgical trauma. The ZPAS could better decrease the incidence of ASD and dysphagia. ZPAS was also accompanied by high subsidence rate and poor cervical alignment.
摘要：
目的：为了比较安全性，采用零轮廓锚定垫片（ZPAS）与钢板和笼（PC）的颈前路椎间盘切除术和融合术（ACDF）治疗三级连续宫颈退行性疾病（CDD）的临床结果和放射学结果。
方法：该研究在PROSPERO（CRD42024512706）注册。WebofScience核心收藏,截至2024年2月12日，搜索了PubMed和Embase。使用了ReviewManager5.3。对二分数据进行相对风险(RR)和95%置信区间(CI)评估。使用平均差异（MD）和95％CI评估连续数据。
结果：纳入了9项研究，比较了ACDF和ZPAS与PC的三级连续CDD。ZPAS的术中出血量和手术时间明显少于PC。沉降率，宫颈对齐的丧失，ZPAS的融合节段高度和椎间盘高度明显大于PC。ZPAS的宫颈排列和6个月内吞咽困难的发生率明显低于PC。根据敏感性分析，当排除一项研究时，ZPAS的ASD明显低于PC。在其他方面没有发现显著差异。
结论：ACDF与ZPAS和PC均安全有效。PC与手术创伤增加有关。ZPAS可以更好地降低ASD和吞咽困难的发生率。ZPAS还伴有高沉降率和不良的宫颈排列。
方法：该研究在PROSPERO（CRD42024512706）注册。WebofScience核心收藏,截至2024年2月12日，搜索了PubMed和Embase。使用了ReviewManager5.3。对二分数据进行相对风险(RR)和95%置信区间(CI)评估。使用平均差异（MD）和95％CI评估连续数据。
结果：纳入了9项研究，比较了ACDF和ZPAS与PC的三级连续CDD。ZPAS的术中出血量和手术时间明显少于PC。沉降率，宫颈对齐的丧失，ZPAS的融合节段高度和椎间盘高度明显大于PC。ZPAS的宫颈排列和6个月内吞咽困难的发生率明显低于PC。根据敏感性分析，当排除一项研究时，ZPAS的ASD明显低于PC。在其他方面没有发现显著差异。
结论：ACDF与ZPAS和PC均安全有效。PC与手术创伤增加有关。ZPAS可以更好地降低ASD和吞咽困难的发生率。ZPAS还伴有高沉降率和不良的宫颈排列。
