{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:17:28Z","timestamp":1788315448634,"version":"build-2803163510"},"reference-count":35,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T00:00:00Z","timestamp":1785024000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100018542","name":"Natural Science Foundation of Sichuan Province","doi-asserted-by":"publisher","award":["2025ZNSFSC1786"],"award-info":[{"award-number":["2025ZNSFSC1786"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Purpose<\/jats:title>\n Cervical curvature loss is a frequent complication following 3\u2010level anterior cervical discectomy and fusion (ACDF) using a Zero\u2010Profile device. Consequently, the capacity of this device to maintain cervical sagittal alignment in 3\u2010level ACDF remains highly controversial. This study aimed to identify potential predictors for postoperative curvature loss (PCL) and evaluate its impact on clinical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n A total of 113 patients who underwent ACDF for 3\u2010level cervical degenerative disc disease (CDDD) between January 2021 and December 2023 were retrospectively reviewed. Demographic data, radiological parameters, and clinical outcomes were analyzed. Radiographic measures included cervical curvature, T1 slope, C2\u20137 sagittal vertical axis, and titanium plate and endplate (TPE) distance. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Statistical analyses were performed using paired and independent\n t<\/jats:italic>\n \u2010tests, as well as Pearson correlation coefficients.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The average curvature loss was 6.82\u00b0 from 1\u2009week postoperatively to the final follow\u2010up (\n p<\/jats:italic>\n \u2009<\u20090.001). However, the final curvature (11.65\u00b0) was maintained, representing a 4.33\u00b0 improvement compared to preoperative values. Significant correlations were observed between PCL and preoperative curvature (\n r<\/jats:italic>\n \u2009=\u2009\u22120.368,\n p<\/jats:italic>\n \u2009=\u20090.013), preoperative T1 slope (\n r<\/jats:italic>\n \u2009=\u2009\u22120.546,\n p<\/jats:italic>\n \u2009<\u20090.001), \u2206T1 slope (\n r<\/jats:italic>\n \u2009=\u20090.443,\n p<\/jats:italic>\n \u2009=\u20090.002), and \u2206TPE distance (\n r<\/jats:italic>\n \u2009=\u20090.417,\n p<\/jats:italic>\n \u2009=\u20090.004). PCL did not correlate with Japanese Orthopaedic Association (JOA) scores or arm VAS scores at the final follow\u2010up. Nevertheless, patients with a PCL\u2009\u2265\u20096\u00b0 exhibited significantly higher neck VAS (\n p<\/jats:italic>\n \u2009=\u20090.028) and NDI scores (\n p<\/jats:italic>\n \u2009=\u20090.041).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Although contiguous 3\u2010level ACDF with a Zero\u2010Profile device may result in PCL, it preserves an improved cervical lordosis compared to the preoperative baseline. Low preoperative curvature and a low preoperative T1 slope are potentially predictive factors for PCL. Postoperative changes in TPE distance and T1 slope are significantly associated with PCL, suggesting a potential biomechanical link that requires direct validation. Furthermore, PCL may lead to higher neck VAS and NDI scores. Consequently, the Zero\u2010Profile device may require careful consideration in 3\u2010level CDDD patients presenting with low preoperative curvature and a low T1 slope. Importantly, the 6\u00b0 PCL threshold identified is preliminary and requires prospective validation before clinical application.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/os.70368","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T02:54:22Z","timestamp":1785120862000},"page":"1819-1827","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Curvature Loss in Three\u2010Level Anterior Cervical Discectomy and Fusion With Zero\u2010Profile Device"],"prefix":"10.1111","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7965-9227","authenticated-orcid":false,"given":"Zhihao","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaqing","family":"Sheng","sequence":"additional","affiliation":[{"name":"Trauma Medical Center, Department of Orthopedics Surgery West China Hospital, Sichuan University Chengdu China"},{"name":"Department of Orthopedics Orthopedics Research Institute, West China Hospital, Sichuan University Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8093-816X","authenticated-orcid":false,"given":"Chengyi","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4884-0725","authenticated-orcid":false,"given":"Tingkui","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kangkang","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8755-1427","authenticated-orcid":false,"given":"Beiyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1823-5457","authenticated-orcid":false,"given":"Chen","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Hong","sequence":"additional","affiliation":[{"name":"West China School of Nursing, Sichuan University Chengdu Sichuan China"},{"name":"Department of Anesthesia and Operation Center West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery West China Hospital, Sichuan University Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,26]]},"reference":[{"issue":"3","key":"e_1_2_14_2_1","first-page":"607","article-title":"The Treatment of Certain Cervical\u2010Spine Disorders by Anterior Removal of the Intervertebral Disc and Interbody Fusion","volume":"40","author":"Smith G. 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