Zhang Yu, Ju Jidong, Wu Jinchun
Department of Orthopaedics, Jingjiang People's Hospital Affiliated to Yangzhou University, Jingjiang, Taizhou, Jiangsu Province, 214500, China.
Eur Spine J. 2025 Feb;34(2):694-706. doi: 10.1007/s00586-024-08613-y. Epub 2024 Dec 19.
For anterior cervical discectomy and fusion (ACDF), stand-alone anchored spacers (SAAS) and cage-plate system (CPS) are currently employed. However, controversy remains over the effectiveness and security of these two apparatuses in multilevel ACDF. The aim of this study was to demonstrate the global long-term effectiveness and safety of SAAS versus CPS with multilevel ACDF.
We conducted a systematic review of studies comparing SAAS with CPS for multilevel ACDF using four electronic databases. Data from this meta-analysis were analyzed with Stata MP 17.0.
A total of nine trials comprising 584 patients were selected for inclusion. SAAS significantly reduced operative time, intraoperative bleeding and the incidence of postoperative dysphagia compared with CPS. The SAAS group exhibited significantly smaller cervical sagittal angle (CSA) and fusion segmental height (FSH) compared to CPS group. At final follow-up, the rate of cage sinking was higher in SAAS group compared to CPS group. At the endpoint, there was no difference in JOA score, NDI score, fusion rate or the incidence of adjacent segment degeneration (ASD).
SAAS provided comparable long-term effectiveness and safeness for multilevel ACDF regarding JOA scores, NDI scores, fusion rates and ASD rates at endpoint compared to CPS. In comparison to CPS, SAAS demonstrated significant advancement in the reduction of operative time, intraoperative blood loss and the incidence of postoperative dysphagia. As a consequence, SAAS appeared more desirable than CPS among people who needed multilevel ACDF. Yet in long-term observation, SAAS was inferior to CPS in maintaining CSA and FSH and in preventing cage descent. However, whether or not radiographic abnormality has an impact on clinical presentation awaits confirmation from research with more longitudinal follow-up.
对于颈椎前路椎间盘切除融合术（ACDF），目前采用独立锚定椎间融合器（SAAS）和椎间融合器-钢板系统（CPS）。然而，在多节段ACDF中，这两种器械的有效性和安全性仍存在争议。本研究的目的是证明SAAS与CPS用于多节段ACDF的全球长期有效性和安全性。
我们使用四个电子数据库对比较SAAS与CPS用于多节段ACDF的研究进行了系统评价。使用Stata MP 17.0对该荟萃分析的数据进行分析。
共纳入9项试验，包括584例患者。与CPS相比，SAAS显著缩短了手术时间、术中出血量和术后吞咽困难的发生率。与CPS组相比，SAAS组的颈椎矢状角（CSA）和融合节段高度（FSH）明显更小。在末次随访时，SAAS组的椎间融合器下沉率高于CPS组。在终点时，日本骨科协会（JOA）评分、颈部功能障碍指数（NDI）评分、融合率或相邻节段退变（ASD）的发生率没有差异。
在终点时，与CPS相比，SAAS在多节段ACDF的JOA评分、NDI评分、融合率和ASD发生率方面提供了相当的长期有效性和安全性。与CPS相比，SAAS在缩短手术时间、减少术中失血量和降低术后吞咽困难发生率方面有显著进展。因此，在需要多节段ACDF的人群中，SAAS似乎比CPS更可取。然而，在长期观察中，SAAS在维持CSA和FSH以及防止椎间融合器下沉方面不如CPS。然而，影像学异常是否对临床表现有影响，有待更多纵向随访研究证实。
