| Objective:This meta-analysis was performed to compare the clinical and radiological outcomes of Zero-P versus plate with cage in the treatment of degenerative cervical spondylosis,and provide a reliable medical evidence for the choice of internal fixation system in ACDF.Methods:The Pub Med,EMBASE and Cochrane Library databases were screened using a computer to search for clinical studies of Zero-P versus plate with cage in the treatment of degenerative cervical spondylosis published before February 2018.The quality of randomized controlled trial was evaluated using the Delphi list.The quality of observational study was evaluated using the Newcastle-Ottawa Scale.The outcomes include general surgical indicator,clinical indicator,imaging parameter,and complication.We used the weighted mean difference and 95% confidence interval to evaluate continuous variables(surgical time,intraoperative blood loss,JOA score,NDI score,cervical Cobb angle),and used the odds ratio and 95% confidence interval to evaluate the dichotomous variables(incidence of dysphagia,fusion rate,subsidence rate,and incidence of adjacent-level ossification development).The chi-square test and I2 test were used to evaluate the heterogeneity of the studies included.When the P > 0.1 and I2 < 50%,the heterogeneity was low and the fixed-effects model was used;when the P < 0.1 and I2 > 50%,heterogeneity was high and a random-effects model was used.The sensitivity analysis was performed by selecting one method from the other.When more than ten studies were included,publication bias was tested using a funnel plot.Statistical analysis was conducted using the Review Manager 5.3 software.Results:19 studies were selected including 2 randomized controlled trials and 17 observational studies.The earliest published time of the study was 2012,and the recent time was February 2018.A total of 1459 cases were included in the study.Among them,Zero-P implant(Zero-P group)had 694 cases,and the plate with cage(PC Group)had 765 cases.There was no significant difference in the preoperative JOA score,NDI score,and cervical Cobb angle,so they had a uniform baseline.Postoperative meta-analysis showed that there was no significant difference in JOA score,NDI score,and fusion rate between the Zero-P group and the PC group;the incidence of dysphagia and the incidence of ALOD in the Zero-P group were significantly smaller than that in the PC group.However,the subsidence rate in the PC group was significantly lower than that in the Zero-P group.Subgroup analysis was performed according to the level of surgery.In the one-level surgery,the operative time and intraoperative blood loss in the Zero-P group were significantly lower than in the PC group.There was no statistically significant difference in cervical Cobb angle for the 1-month and the last follow-up.In multilevel surgery,there was no significant difference in operative time and blood loss between the two groups.There was no statistically significant difference in cervical Cobb angles in 1 month and 3 month after surgery in both groups.However,the Zero-P group was significantly smaller than the PC group of cervical Cobb angle for the last follow-up.Conclusion:The both of internal fixation systems have the similar clinical efficacy and fusion rate.Zero-P could effectively reduce the incidence of dysphagia and incidence of ALOD,but increase the subsidence rate.In one-level surgery,the results of restoration and long-term maintenance of cervical curvature in the both groups were approximately the same,but the Zero-P group had less operative time and less blood loss.In multilevel surgery,the operative time and intraoperative blood loss were approximately the same in both groups,but the PC group had an advantage of maintaining cervical curvature in a long time.The amount of literature included is limited for that the time of Zero-P coming into clinical use is not very long.Large samples,longer-term,multicenter randomized controlled trials are required to update and validate the conclusions. |
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