Comparison of two zero-profile implants for treating degenerative cervical disc disease: a quantitative synthesis analysis comparing artificial cervical disc prosthesis and zero-profile cage

This study aimed to investigate effectiveness and safety of artificial disc replacement (ADR) versus anterior cervical discectomy and fusion with zero-profile cages (ZPC) for treating single-segment degenerative cervical disc disease (DCDD). Comprehensive search was conducted across four databases, including PubMed, Embase, Web of Science, and Cochrane Library, for studies comparing ADR versus ZPC for managing DCDD from beginning to November 28, 2025. Quantitative synthesis analyses were carried out via Stata 17. Eleven publications were involved in our analysis. In managing single-level DCDD, ADR exhibited significantly shorter surgical duration [WMD = − 4.98, 95% CI (− 7.8, − 2.16), p < 0.01], greater range of motion at the surgical level [WMD = 5.35, 95% CI (3.75, 6.96), p < 0.01], and lower subsidence rates [OR = 0.35, 95% CI (0.23, 0.54), p < 0.01] compared with ZPC. No significant differences were observed between both groups concerning blood loss, neck disability index, Japanese Orthopaedic Association scores, visual analog scale scores, cervical curvature, reoperation rate, dysphagia rate, or adjacent segment degeneration rate ( p > 0.05). Our study indicates ADR is associated with significantly shorter surgical duration, enhanced range of motion, and reduced subsidence rates when compared to ZPC for treating single-level DCDD. Both zero-profile implants yield comparable satisfactory outcomes. However, ADR appears to be superior to ZPC in shortening operative time, decreasing subsidence rate, and enhancing range of motion at the surgical level.