Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review
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REVIEW ARTICLE
Locking stand‑alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta‑analysis based on randomized controlled trials Yachao Zhao1 · Sidong Yang1 · Yachong Huo1 · Zhaohui Li1 · Dalong Yang1 · Wenyuan Ding1 Received: 12 January 2020 / Revised: 15 June 2020 / Accepted: 2 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF). Methods A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration’s tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software. Results A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC. Conclusion In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures. Keywords Locking stand-alone cage · Plate · Anterior cervical discectomy and fusion · Degenerative cervical disease · Randomized controlled trial · Meta-analysis
Introduction Since introduction by Smith and Robinson [1], anterior cervical discectomy and fusion (ACDF) has become an effective procedure commonly performed for degenerative cervical diseases (DCD). Traditionally, anterior plate construct (APC) is considered a standard device following ACDF to maintain cervical stability, promote interbody fusion, and reduce cage dislocation [2–4]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-020-06561-x) contains supplementary material, which is available to authorized users. * Wenyuan Ding [email protected] 1
Department of Spine Surgery, The Third Hospital of Hebei Medical University, No.139 Ziqiang Road, Shijiazhuang 050051, Hebei, People’s Republic of China
However, the application of APC appears to cause adverse events especially in multi-level ACDF, such as implant failure, post-operative dysphagia, neurovascular injuries, and adjacent segment degeneration (ASD) [5–7]. In response to the above concerns, locking stand-alone cage (LSC), a low-profile device with an integrated plate to avoid plateto-soft tiss
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