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Research article
Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis
Xuesong Zhu
First Affiliated Hospital of Soochow University
Corresponding Author
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This work is licensed under a CC BY 4.0 License. Read Full License
Background: The zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate.
Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software.
Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥ 2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time.
Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.
Keywords
Anterior fusion, Cervical degenerative disease, Zero-profile device, Subsidence, Meta-analysis
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Editorial decision: Minor revision
On 11 Apr, 2020
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On 07 Apr, 2020
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On 06 Apr, 2020
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Review #1 received
Received 31 Mar, 2020
Editorial decision: Minor revision
On 31 Mar, 2020
Reviewers invited
Invitations sent on 29 Mar, 2020
Reviewer #1 agreed
On 29 Mar, 2020
Editor assigned
On 23 Mar, 2020
Submission checks complete
On 22 Mar, 2020
Editor invited
On 22 Mar, 2020
No comments provided
Review #1 received
Received 15 Mar, 2020
Editorial decision: Major revision
On 15 Mar, 2020
Review #2 received
Received 13 Mar, 2020
Reviewer #2 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Editor assigned
On 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
No comments provided
Editorial decision: Major revision
On 23 Jan, 2020
Review #3 received
Received 20 Jan, 2020
Review #2 received
Received 20 Jan, 2020
Review #1 received
Received 16 Jan, 2020
Reviewer #3 agreed
On 09 Jan, 2020
Reviewer #2 agreed
On 08 Jan, 2020
Reviewer #1 agreed
On 04 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 02 Jan, 2020
Editor invited
On 01 Jan, 2020
Submission checks complete
On 23 Dec, 2019
First submitted
On 19 Dec, 2019
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Subject Areas
Orthopedic Surgery
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This preprint is under consideration at Journal of Orthopaedic Surgery and Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Does zero-profile anchored cage accompanied by a higher postoperative subsidence compared with cage-plate construct? A meta-analysis
Xuesong Zhu
First Affiliated Hospital of Soochow University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 13 Apr, 2020
No community comments so far
Editorial decision: Minor revision
On 11 Apr, 2020
Editor assigned
On 07 Apr, 2020
Submission checks complete
On 06 Apr, 2020
Editor invited
On 06 Apr, 2020
No comments provided
Review #1 received
Received 31 Mar, 2020
Editorial decision: Minor revision
On 31 Mar, 2020
Reviewers invited
Invitations sent on 29 Mar, 2020
Reviewer #1 agreed
On 29 Mar, 2020
Editor assigned
On 23 Mar, 2020
Submission checks complete
On 22 Mar, 2020
Editor invited
On 22 Mar, 2020
No comments provided
Review #1 received
Received 15 Mar, 2020
Editorial decision: Major revision
On 15 Mar, 2020
Review #2 received
Received 13 Mar, 2020
Reviewer #2 agreed
On 02 Mar, 2020
Reviewers invited
Invitations sent on 29 Feb, 2020
Reviewer #1 agreed
On 29 Feb, 2020
Editor assigned
On 24 Feb, 2020
Submission checks complete
On 23 Feb, 2020
Editor invited
On 23 Feb, 2020
No comments provided
Editorial decision: Major revision
On 23 Jan, 2020
Review #3 received
Received 20 Jan, 2020
Review #2 received
Received 20 Jan, 2020
Review #1 received
Received 16 Jan, 2020
Reviewer #3 agreed
On 09 Jan, 2020
Reviewer #2 agreed
On 08 Jan, 2020
Reviewer #1 agreed
On 04 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 02 Jan, 2020
Editor invited
On 01 Jan, 2020
Submission checks complete
On 23 Dec, 2019
First submitted
On 19 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedic Surgery
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The zero-profile anchored cage (ZP) has been widely used for its lower occurrence of dysphagia. However, it is still controversial whether it has the same stability as the cage-plate construct (CP) and increases the incidence of postoperative subsidence. We compared the rate of subsidence after anterior cervical discectomy and fusion (ACDF) with ZP and CP to determine whether the zero-profile device had a higher subsidence rate.
Methods: We performed a meta-analysis of studies that compared the subsidence rates of ZP and CP. An extensive and systematic search covered the Medline, Embase and Web of Science databases according to the PRISMA guidelines and identified ten articles that satisfied our inclusion criteria. Relevant clinical and radiological data were extracted and analyzed by RevMan 5.3 software.
Results: Ten trials involving 626 patients were included in this meta-analysis. The incidence of postoperative subsidence in the ZP group was significantly higher than that in the CP group [15.1% (89/588) vs. 8.8% (51/581), OR = 1.97 (1.34, 2.89), P = 0.0005]. In the subgroup analysis, we found that the definition of subsidence did not affect the higher subsidence rate in the ZP group. Considering the quantity of operative segments, there was no significant difference in the incidence of subsidence between the two groups after single-level fusion (OR 1.43, 95% CI 0.61-3.37, P = 0.41). However, the subsidence rate of the ZP group was significantly higher than that of the CP group (OR 2.61, 95% CI 1.55-4.40, P = 0.0003) after multilevel (≥ 2-level) procedures. There were no significant differences in intraoperative blood loss, JOA score, NDI score, fusion rate or cervical alignment in the final follow-up between the two groups. In addition, the CP group had a longer operation time and a higher incidence of dysphagia than the ZP group at each follow-up time.
Conclusion: Based on the limited evidence, we suggest that ZP has a higher risk of postoperative subsidence than CP, although with elevated swallowing discomfort. A high-quality, multi-center randomized controlled trial is required to validate our results in the future.
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