A Comparative Analysis of the Clinical and Radiological Results of a Zero-Profile Device Versus Conventional Cage and Plate Following Single-Level Anterior Cervical Discectomy and Fusion

Background Conventional cage and plating (CCP) and stand-alone self-interlocking zero profile cage (ZPC) are the two devices used in anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylosis refractory to medical treatment. The utilization of zero-profile implants in ACDF for the management of degenerative cervical spondylosis has gained popularity. Nevertheless, the available evidence regarding its effectiveness and safety remains insufficient. Objective To compare the clinical and radiological outcomes of CCP and ZPC for single-level ACDF. Methodology In this retrospective cohort study, the records of patients who underwent single-level ACDF with CCP and ZPC between December 2021 and December 2023 were recruited in December 2024. Patients with ossified posterior longitudinal ligament, history of previous cervical surgery, severe comorbidities, older than 70 years and patients who utilized the circumferential fusion approach in combination were excluded from the study. The means and frequencies of clinical and radiological outcomes were compared between two groups via Mann-Whitney test, Fisher's exact test, and Chi-square test of significance, where p<0.05 was considered significant. The six-month follow-up data were recorded for all the patients included in the study. Results Of the 53 included patients, CCP was utilized in 30 (56.6%) and ZPC in 23 (43.4%) patients. The mean age of study participants was 53.8±9.3 years, with 35 (66%) males and 18 (34%) females. The ZPC implant resulted in reduced blood loss (p=0.001). However, no statistically significant difference was observed in operation time and the incidence of postoperative transient dysphagia between the two groups (p=0.532, p=0.569, respectively). Additionally, the ZPC implant demonstrated a significantly lower occurrence of postoperative dysphagia at two weeks and six months postoperatively (p=0.015 and p=0.039 respectively) compared to the CCP implant. Conclusion The utilization of ZPC may lead to positive clinical and radiological outcomes and decrease the frequency of postoperative dysphagia in ACDF procedures involving a single level.