Comparison of ROI ⁃ C and traditional cage combined with titanium plate internal fixation for anterior cervical discectomy and fusion

Abstract

Objective Comparative analysis of the efficacy and safety of zero⁃notch self⁃locking interbody fusion system (ROI⁃C) and traditional cage combined with titanium plate internal fixation technology in the anterior cervical discectomy and fusion (ACDF). Methods A total of 116 patients with cervical degenerative diseases who underwent ACDF in Tianjin Union Medical Center from January 2014 to December 2016 were included, of which 60 patients underwent the ROI⁃C (ROI⁃C group) and 56 patients underwent traditional cage combined with titanium plate internal fixation (titanium plate group). According to cervical vertebral X⁃ray and CT, Japanese Orthopaedic Association Scores (JOA), Neck Disability Index (NDI) and Bazaz dysphagia classification, the physiological curvature and intervertebral space height of cervical vertebal before and after surgery were compared and analyzed, and the degree of neurology function and quality of daily life recovery, and incidence of dysphagia at 1, 3, 6, and 12 months after surgery were evaluated. The imaging examination were set at 12 months after surgery to evaluate the fusion failure phenomenon such as cage subsidence, pseudoarthrosis, and the degeneration of adjacent vertebral segments, as well as respiratory, esophageal injury or esophageal fistula, cerebrospinal fluid (CBF) leakage, internal fixation rejection, wound infection and postoperative hematoma. Results Compared with titanium plate group, patients with single⁃segment or double⁃segment lesions in ROI⁃C group showed shorter operation time (t=5.619, P=0.001; t=3.110, P=0.002), and decreased intraoperative blood loss (t=7.448, P=0.001; t=5.946, P=0.001), increased postoperative cervical physiological curvature (F=82.424, P=0.024), increased intervertebral space height (F=43.427, P=0.021), increased JOA score (F=16.024, P=0.016) and decreased NDI index (F=21.439, P=0.024). The difference between the physiological curvature of cervical spine (F=70.247, P=0.000), intervertebral space height (F=35.312, P=0.000), JOA score (F=13.420, P=0.000) and NDI index (F=19.523, P=0.000) before and after surgery in 2 groups was statistically significant at 1, 3, 6 and 12 months of follow⁃up, the measured data of cervical physiological curvature (P=0.001, for all) and intervertebral space height (P=0.001, for all) were higher than those before surgery, the JOA score increased (P=0.001, for all) and the NDI index decreased (P=0.001, for all). There was no significant difference in the incidence of dysphagia one week after surgery [48.21% (27/56) vs. 33.33% (20/60); χ2=2.661, P=0.103]. The incidence of dysphagia in the titanium plate group was higher than that in the ROI⁃C group at 12 months after surgery [16.07% (9/56) vs. 0 (0/60); χ2=6.779, P=0.009]. In addition, no incision infection, respiratory tract, oesophagal injury, oesophagal fistula, internal fixation rejection and other related complications occurred during the 12⁃month follow⁃up period. One case of CBF leakage during single⁃segment ACDF surgery with ROI⁃C. Hematoma and upper adjacent vertebral segment degeneration occurred in one patient in each group. Conclusions ACDF surgery with ROI⁃C has good efficacy and safety, it is suitable for treating patients with cervical degenerative diseases with single⁃segment or continuous double⁃segment lesions.

Keywords

• cervical vertebrae
• diskectomy
• spinal fusion
• postoperative complications