| ObjectiveTo compare the medium-long term efficacy of contiguous two-level anterior cervical discectomy and fusion(ACDF)with Zero-Profile implant and plate and cage.MethodsA total of 20 patients for contiguous two-level anterior cervical discectomy and fusion admitted from January 2010 to December 2014 who met the surgical indications were selected as the Zero-P group,and 26 patients were selected as the plate and cage group.The incision length,intraoperative blood loss,operation time,postoperative drainage and perioperative complications were compared.The VAS,JOA and NDI scores were obtained at preoperative,1 week,3 months,1 year and the last follow-up.The cervical radiograms were reviewed at 1 week,3 months,1 year and the last follow-up after surgery.The Cobb angle,cage subsidence and adjacent segment degeneration were measured.Postoperative dysphagia was recorded according to the Bazaz dysphagia grade.ResultThere was no significant difference in gender,age,follow-up time and surgical segment between the two groups(P>0.05).The operation time,intraoperative bleeding,surgical incision length and postoperative drainage were(103.3±16.64)min,(106.5 ±29.78)ml,(4.8±0.70)cm and(24.1±14.84)ml in the Zero-P,and(116.5 ± 23.57)min,(160.4±93.70)ml,(5.5±0.71)cm and(41.9±12.49)ml in the plate and cage group respectively.There were statistically significant differences between the two groups in operation time,intraoperative hemorrhage,surgical incision length and postoperative drainage(P<0.05).VAS score,JOA score,NDI score and cervical Cobb angle at each postoperative follow-up time point of the two groups were significantly different from those before operation(P<0.05).Except significant difference of cervical Cobb angle between the two groups at the last follow-up(P<0.05),the differences of other indicators between the two groups at the same time point were not statistically significant(P>0.05).There was statistically significant difference in the incidence and severity of dysphagia between the two groups 3 months after surgery(P<0.05).1 case of moderate dysphagia and 1 case of mild dysphagia were found in the plate and cage group were followed up for 1 year after the operation.No patients in the Zero-P group reported dysphagia,but there was no statistically significant difference between the two groups(P>0.05).There was no dysphagia in both groups at the last follow-up.At the last follow-up,all patients in the two groups obtained bone fusion,and there was no statistical difference between the two groups(P>0.05).There was 1 case of cage sinking in the Zero-P group and no cage sinking in the plate and cage group.The difference between the two groups was not statistically significant(P>0.05).At the last follow-up,there was no adjacent segment degeneration in the Zero-P group,while there were 3 cases of adjacent segment degeneration in the plate and cage group.There was no statistically significant difference between the two groups(P>0.05),but there was an increasing trend in the plate and cage group.ConclusionIn the case of two-level ACDF,both Zero-P and plate and cage could obtain satisfactory efficacy and improve the quality of life.However,Zero-P has the advantages of shorter operation time,less intraoperative bleeding,smaller incision and less postoperative drainage.In the middle and long term,the effects of reducing pain and improving neurological function are similar.The incidence and degree of early dysphagia in the Zero-P group was lower than that in the plate and cage group,but there was no significant difference in the medium-long term.There was no significant difference between the two groups in fusion rate,cage subsidence rate and the incidence of adjacent segment degeneration,but there was an increasing trend of the adjacent segment degeneration in the plate and cage group. |
