Our Summary

This research paper compares two different surgical methods for treating cervical spondylotic myelopathy (CSM), a condition that affects the neck and spinal cord. The two methods examined are Anterior Cervical Diskectomy and Fusion (ACDF) using a Zero-profile (ZP) device and a Cage-plate (CP) construct. The study aimed to understand how these methods affect the alignment of the neck over a long period of time.

The researchers analyzed 14 different studies, which included over 1000 participants. They found that patients treated with the ZP device had lower rates of difficulty swallowing (dysphagia) after surgery and fewer instances of additional spinal degeneration (ASD) at their last check-up compared to those treated with the CP construct.

The researchers also looked at X-ray results to assess neck alignment after surgery. They found no significant difference between the two surgical methods in the immediate aftermath of the operation and at the final check-up. However, they did find that the angle of the neck (cervical Cobb angle) was significantly smaller in patients treated with the ZP device compared to those treated with the CP construct.

Interestingly, this difference in neck angle was not apparent when the final check-up was less than 3 years after surgery. But as more time passed, the neck angle was significantly lower in the ZP group compared to the CP group.

In conclusion, the study suggests that using a ZP device in ACDF surgery results in a lower rate of postoperative dysphagia and ASD than with a CP construct. Both methods were found to be safe and effective in correcting neck alignment, but over time, the ZP device resulted in greater changes in neck alignment. The researchers suggest that additional large clinical studies with a longer follow-up period are needed to further understand these findings.

FAQs

  1. What is the primary difference between the Anterior Cervical Diskectomy and Fusion (ACDF) using a Zero-profile (ZP) device and a Cage-plate (CP) construct?
  2. Did the study find any significant differences in neck alignment after surgery between the two surgical methods?
  3. What are the long-term effects of using a ZP device in ACDF surgery compared to a CP construct?

Doctor’s Tip

A doctor may advise a patient undergoing discectomy to consider using a Zero-profile (ZP) device over a Cage-plate (CP) construct, as it may lead to lower rates of difficulty swallowing and additional spinal degeneration in the long term. They may also recommend regular follow-up appointments to monitor changes in neck alignment over time.

Suitable For

Patients who are typically recommended for discectomy are those with cervical spondylotic myelopathy (CSM), a condition that affects the neck and spinal cord. Symptoms of CSM can include neck pain, weakness in the arms or legs, numbness or tingling in the extremities, and difficulty walking. Discectomy may be recommended for patients who have not found relief from conservative treatments such as physical therapy, medications, or injections. Patients who have significant compression of the spinal cord or nerve roots due to a herniated disc or bone spurs may benefit from discectomy surgery to alleviate pressure on the spinal cord and improve symptoms.

Timeline

Before discectomy:

  1. Patient experiences symptoms of cervical spondylotic myelopathy (CSM) such as neck pain, weakness, numbness, and difficulty walking.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to confirm the diagnosis.
  3. Patient may undergo conservative treatments such as physical therapy, medication, and injections to manage symptoms.
  4. If symptoms persist and conservative treatments are not effective, patient may be recommended for discectomy surgery.

After discectomy:

  1. Patient undergoes discectomy surgery, either with an Anterior Cervical Diskectomy and Fusion (ACDF) using a Zero-profile (ZP) device or a Cage-plate (CP) construct.
  2. In the immediate aftermath of surgery, patient may experience pain, swelling, and limited mobility in the neck.
  3. Patient is monitored in the hospital for a few days and then discharged with instructions for post-operative care and rehabilitation.
  4. Over time, patient undergoes physical therapy to regain strength and mobility in the neck.
  5. Patient is followed up with regular check-ups and imaging studies to monitor neck alignment and overall recovery.
  6. Patient may experience improvements in symptoms such as pain, weakness, and numbness as the neck heals and the spinal cord decompresses.
  7. Long-term outcomes include improved quality of life, reduced risk of additional spinal degeneration, and potential changes in neck alignment depending on the surgical method used.

What to Ask Your Doctor

Some questions a patient should ask their doctor about discectomy based on this research paper include:

  1. What are the potential risks and benefits of using a Zero-profile (ZP) device versus a Cage-plate (CP) construct in Anterior Cervical Diskectomy and Fusion (ACDF) surgery?
  2. How does each surgical method affect the likelihood of experiencing difficulty swallowing (dysphagia) after surgery?
  3. What are the differences in additional spinal degeneration (ASD) rates between the ZP device and CP construct?
  4. How does each surgical method impact neck alignment immediately after surgery and over a long period of time?
  5. Are there any specific factors that may make one surgical method more suitable for me than the other based on my individual circumstances?
  6. What is the expected recovery process and timeline for each surgical method?
  7. Are there any potential long-term implications or considerations to keep in mind when choosing between the ZP device and CP construct?
  8. Are there any ongoing or upcoming clinical studies that may provide further insights into the effectiveness and safety of these surgical methods?
  9. What are the success rates and patient satisfaction levels associated with each surgical method in treating cervical spondylotic myelopathy (CSM)?
  10. Can you provide me with more information about the experience and expertise of the surgical team in performing ACDF surgery with either the ZP device or CP construct?

Reference

Authors: Liu Z, Yang Y, Lan J, Xu H, Zhang Z, Miao J. Journal: J Orthop Surg Res. 2022 Nov 24;17(1):510. doi: 10.1186/s13018-022-03400-1. PMID: 36434715