TY - JOUR
T1 - Locking stand-alone cages versus anterior plate constructs in single-level fusion for degenerative cervical disease
T2 - a systematic review and meta-analysis
AU - Nambiar, Mithun
AU - Phan, Kevin
AU - Cunningham, John Edward
AU - Yang, Yi
AU - Turner, Peter Lawrence
AU - Mobbs, Ralph
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Purpose: To conduct a meta-analysis to compare the clinical and radiological outcomes in single-level anterior cervical discectomy and fusion (ACDF) surgery for degenerative cervical disease performed by either single-level locking stand-alone cage (LSC) or anterior plate construct (APC). Methods: We performed a comprehensive database search of Medline, PubMed, EMBASE and Cochrane Database of Systematic Reviews according to PRISMA guidelines and identified six articles that satisfied our inclusion criteria. We excluded all non-English language articles and articles which did not directly compare LSC and APC. Only papers which focussed on single-level ACDF were included in the study. Results: There were no significant differences in blood loss, clinical outcomes (JOA, VAS, NDI scores) or radiological outcomes (cervical lordosis, segmental Cobb angle, subsidence and fusion) between the two groups. Operative time was significantly shorter in the LSC group (MD 7.2 min, 95% CI 0.3–14.1, p = 0.04). APC was associated with a statistically significant increase in dysphagia in the follow-up period (OR 6.2, 95% CI 1.0–36.6, p = 0.05). Conclusion: LSC and APC have similar clinical and radiological outcomes. Further blinded randomised trials are required to establish conclusive evidence in favour of LSC with regards to minimising post-operative dysphagia. We also encourage future studies to make use of formalised dysphagia outcome measures in reporting complications.
AB - Purpose: To conduct a meta-analysis to compare the clinical and radiological outcomes in single-level anterior cervical discectomy and fusion (ACDF) surgery for degenerative cervical disease performed by either single-level locking stand-alone cage (LSC) or anterior plate construct (APC). Methods: We performed a comprehensive database search of Medline, PubMed, EMBASE and Cochrane Database of Systematic Reviews according to PRISMA guidelines and identified six articles that satisfied our inclusion criteria. We excluded all non-English language articles and articles which did not directly compare LSC and APC. Only papers which focussed on single-level ACDF were included in the study. Results: There were no significant differences in blood loss, clinical outcomes (JOA, VAS, NDI scores) or radiological outcomes (cervical lordosis, segmental Cobb angle, subsidence and fusion) between the two groups. Operative time was significantly shorter in the LSC group (MD 7.2 min, 95% CI 0.3–14.1, p = 0.04). APC was associated with a statistically significant increase in dysphagia in the follow-up period (OR 6.2, 95% CI 1.0–36.6, p = 0.05). Conclusion: LSC and APC have similar clinical and radiological outcomes. Further blinded randomised trials are required to establish conclusive evidence in favour of LSC with regards to minimising post-operative dysphagia. We also encourage future studies to make use of formalised dysphagia outcome measures in reporting complications.
KW - ACDF
KW - Cervical
KW - Plate
KW - Stand-alone
KW - Zero-profile
UR - http://www.scopus.com/inward/record.url?scp=85014741863&partnerID=8YFLogxK
U2 - 10.1007/s00586-017-5015-9
DO - 10.1007/s00586-017-5015-9
M3 - Review Article
C2 - 28283840
AN - SCOPUS:85014741863
SN - 0940-6719
VL - 26
SP - 2258
EP - 2266
JO - European Spine Journal
JF - European Spine Journal
IS - 9
ER -