{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T22:39:09Z","timestamp":1784673549403,"version":"3.55.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Science and Technology Development Fund of Shanghai Pudong New Area","award":["PKJ2023-Y40"],"award-info":[{"award-number":["PKJ2023-Y40"]}]},{"name":"Academic Leaders Program of Health Committee of Pudong New Area","award":["PWRd2023-07"],"award-info":[{"award-number":["PWRd2023-07"]}]},{"name":"Shanghai East Hospital Xuri Young Excellent Talents Program","award":["2019xrrcjh04"],"award-info":[{"award-number":["2019xrrcjh04"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Study design<\/jats:title>\n                <jats:p>A retrospective study.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>The aim of this study was to compare clinical and radiological outcomes of the anterior cervical discectomy and fusion (ACDF) with a novel zero-profile variable-angle (Zero-P VA) spacer and a traditional poly-ether-ether-ketone (PEEK) cage and plate system in cases pertaining to cervical radiculopathy\/myelopathy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Summary of background data<\/jats:title>\n                <jats:p>There are two conventional types of ACDF procedures aimed at treating symptomatic cervical spondylosis. The first one involves an uninstrumented \u201cstand-alone\u201d approach utilizing bone graft\/cage, while the second incorporates bone graft\/cage in conjunction with a front plate positioned before the vertebral bodies. Both procedures have their own inherent advantages and disadvantages. The Zero-P VA spacer, however, represents a unique synthesis by amalgamating the advantages of both traditionally typical procedures. Notably, this spacer can potentially circumvent the issue related to prevertebral soft-tissue disturbance and reduce the occurrence of dysphagia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Using our surgical database, the authors systematically conducted a retrospective analysis encompassing all patients who underwent single-level ACDF between January 2018 and January 2019, with a minimum two-year follow-up. Patients either received a Zero-P VA implant or PEEK cage coupled with plating. The Japanese Orthopedic Association (JOA) score and Visual Analogue Scale (VAS) for arm and neck pain were documented. Dysphagia was evaluated using the Eating Assessment Tool-10 (ETA-10). Additional parameters such as cervical alignment, fusion rate and the incidence of postoperative complications were assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>According to the outcomes of the statistical analysis, there was no substantial disparity that emerged in the advancements observed in the JOA and VAS metrics between the two study cohorts. Noteworthy, however, the ETA-10 scores were statistically significantly reduced in the Zero-P VA group compared to the cage and plating group (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). At the final follow-up, there were no statistically significant differences in the height of the operated segment, Cobb angle of the fused segment, C2\u2013C7 Cobb angle and fusion rate between the two groups (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). However, postoperative complications were slightly lower in patients with the Zero-P VA group (7.69%) as compared to the cage and plating group (16.67%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The clinical outcomes observed with the Zero-P VA spacer used for single-level ACDF were found to be satisfactory. The performance of this device is comparable or even superior to the traditional cage and plating method in preventing postoperative dysphagia and mitigating potential complications associated with the use of a plate.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13018-024-04539-9","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T08:02:15Z","timestamp":1704960135000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Anterior cervical discectomy and fusion with a zero-profile VA spacer device: a clinical and radiological study with two-year follow-up"],"prefix":"10.1186","volume":"19","author":[{"given":"Hai-Hong","family":"Zhao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao-Wei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan-Jin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"De-Sheng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"4539_CR1","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1016\/j.wneu.2017.05.045","volume":"104","author":"MJ Tong","year":"2017","unstructured":"Tong MJ, Xiang GH, He ZL, et al. Zero-profile spacer versus cage-plate construct in anterior cervical diskectomy and fusion for multilevel cervical spondylotic myelopathy: systematic review and meta-analysis. World Neurosurg. 2017;104:545\u201353.","journal-title":"World Neurosurg"},{"issue":"1","key":"4539_CR2","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s12891-018-2017-7","volume":"19","author":"LN Wang","year":"2018","unstructured":"Wang LN, Hu BW, Wang L, et al. Clinical and radiographic outcome of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease: a minimal five-year follow-up. BMC Musculoskelet Disord. 2018;19(1):101.","journal-title":"BMC Musculoskelet Disord"},{"issue":"5","key":"4539_CR3","doi-asserted-by":"publisher","first-page":"496","DOI":"10.3171\/spi.2007.6.5.496","volume":"6","author":"RB Cloward","year":"2007","unstructured":"Cloward RB. The anterior approach for removal of ruptured cervical disks. 1958. J Neurosurg Spine. 2007;6(5):496\u2013511.","journal-title":"J Neurosurg Spine"},{"issue":"26","key":"4539_CR4","doi-asserted-by":"publisher","first-page":"2886","DOI":"10.1097\/BRS.0b013e3181b64f2c","volume":"34","author":"KJ Song","year":"2009","unstructured":"Song KJ, Taghavi CE, Lee KB, et al. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976). 2009;34(26):2886\u201392.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"4539_CR5","first-page":"229","volume":"50","author":"MG Kaiser","year":"2002","unstructured":"Kaiser MG, Haid RW Jr, Subach BR, et al. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229\u201336 (discussion 236\u2013228).","journal-title":"Neurosurgery"},{"issue":"1","key":"4539_CR6","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1186\/s12891-016-1274-6","volume":"17","author":"M Yin","year":"2016","unstructured":"Yin M, Ma J, Huang Q, et al. The new Zero-P implant can effectively reduce the risk of postoperative dysphagia and complications compared with the traditional anterior cage and plate: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2016;17(1):430.","journal-title":"BMC Musculoskelet Disord"},{"issue":"12","key":"4539_CR7","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1177\/000348940811701210","volume":"117","author":"PC Belafsky","year":"2008","unstructured":"Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;117(12):919\u201324.","journal-title":"Ann Otol Rhinol Laryngol"},{"issue":"13","key":"4539_CR8","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1097\/BRS.0000000000000940","volume":"40","author":"JM Rhee","year":"2015","unstructured":"Rhee JM, Chapman JR, Norvell DC, et al. Radiological determination of postoperative cervical fusion: a systematic review. Spine (Phila Pa 1976). 2015;40(13):974\u201391.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"8","key":"4539_CR9","doi-asserted-by":"publisher","first-page":"1666","DOI":"10.1007\/s00586-015-3919-9","volume":"24","author":"Y Chen","year":"2015","unstructured":"Chen Y, Chen H, Cao P, et al. Anterior cervical interbody fusion with the Zero-P spacer: mid-term results of two-level fusion. Eur Spine J. 2015;24(8):1666\u201372.","journal-title":"Eur Spine J"},{"issue":"Suppl 1","key":"4539_CR10","doi-asserted-by":"publisher","first-page":"S41","DOI":"10.1007\/s00590-013-1244-8","volume":"23","author":"H Li","year":"2013","unstructured":"Li H, Min J, Zhang Q, et al. Dynamic cervical plate versus static cervical plate in the anterior cervical discectomy and fusion: a systematic review. Eur J Orthop Surg Traumatol. 2013;23(Suppl 1):S41-46.","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"5","key":"4539_CR11","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1097\/01.bsd.0000177211.44960.71","volume":"18","author":"MJ Lee","year":"2005","unstructured":"Lee MJ, Bazaz R, Furey CG, et al. Influence of anterior cervical plate design on Dysphagia: a 2-year prospective longitudinal follow-up study. J Spinal Disord Tech. 2005;18(5):406\u20139.","journal-title":"J Spinal Disord Tech"},{"issue":"2","key":"4539_CR12","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/00007632-199801150-00006","volume":"23","author":"GL Lowery","year":"1998","unstructured":"Lowery GL, McDonough RF. The significance of hardware failure in anterior cervical plate fixation. Patients with 2- to 7-year follow-up. Spine (Phila Pa 1976). 1998;23(2):181\u20136 (discussion 186\u2013187).","journal-title":"Spine (Phila Pa 1976)"},{"issue":"22","key":"4539_CR13","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1097\/00007632-200211150-00007","volume":"27","author":"R Bazaz","year":"2002","unstructured":"Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):2453\u20138.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"4539_CR14","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.wneu.2011.07.004","volume":"77","author":"S Kalb","year":"2012","unstructured":"Kalb S, Reis MT, Cowperthwaite MC, et al. Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg. 2012;77(1):183\u20137.","journal-title":"World Neurosurg"},{"issue":"6","key":"4539_CR15","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s00586-017-5311-4","volume":"27","author":"J Liu","year":"2018","unstructured":"Liu J, Hai Y, Kang N, et al. Risk factors and preventative measures of early and persistent dysphagia after anterior cervical spine surgery: a systematic review. Eur Spine J. 2018;27(6):1209\u201318.","journal-title":"Eur Spine J"},{"issue":"2","key":"4539_CR16","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.spinee.2004.06.022","volume":"5","author":"GR Fogel","year":"2005","unstructured":"Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J. 2005;5(2):140\u20134.","journal-title":"Spine J"},{"issue":"1","key":"4539_CR17","doi-asserted-by":"publisher","first-page":"302","DOI":"10.21037\/jss.2020.01.14","volume":"6","author":"TJ Yee","year":"2020","unstructured":"Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg. 2020;6(1):302\u201322.","journal-title":"J Spine Surg"},{"issue":"1","key":"4539_CR18","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13018-022-02940-w","volume":"17","author":"T Zhang","year":"2022","unstructured":"Zhang T, Guo N, Gao G, et al. Comparison of outcomes between Zero-p implant and anterior cervical plate interbody fusion systems for anterior cervical decompression and fusion: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2022;17(1):47.","journal-title":"J Orthop Surg Res"},{"issue":"7","key":"4539_CR19","doi-asserted-by":"publisher","first-page":"E413","DOI":"10.1097\/BRS.0000000000002441","volume":"43","author":"JD Oliver","year":"2018","unstructured":"Oliver JD, Goncalves S, Kerezoudis P, et al. Comparison of outcomes for anterior cervical discectomy and fusion with and without anterior plate fixation: a systematic review and meta-analysis. Spine. 2018;43(7):E413\u201322.","journal-title":"Spine"},{"issue":"22","key":"4539_CR20","doi-asserted-by":"publisher","first-page":"2564","DOI":"10.1097\/01.brs.0000186317.86379.02","volume":"30","author":"LH Riley 3rd","year":"2005","unstructured":"Riley LH 3rd, Skolasky RL, Albert TJ, et al. Dysphagia after anterior cervical decompression and fusion: prevalence and risk factors from a longitudinal cohort study. Spine (Phila Pa 1976). 2005;30(22):2564\u20139.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"4539_CR21","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1177\/2192568218774576","volume":"9","author":"ZB Cheung","year":"2019","unstructured":"Cheung ZB, Gidumal S, White S, et al. Comparison of anterior cervical discectomy and fusion with a stand-alone interbody cage versus a conventional cage-plate technique: a systematic review and meta-analysis. Global Spine J. 2019;9(4):446\u201355.","journal-title":"Global Spine J"},{"issue":"43","key":"4539_CR22","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000012893","volume":"97","author":"J You","year":"2018","unstructured":"You J, Tang X, Gao W, et al. Factors predicting adjacent segment disease after anterior cervical discectomy and fusion treating cervical spondylotic myelopathy: a retrospective study with 5-year follow-up. Medicine (Baltimore). 2018;97(43): e12893.","journal-title":"Medicine (Baltimore)"},{"key":"4539_CR23","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.12659\/MSM.913630","volume":"25","author":"P Ouyang","year":"2019","unstructured":"Ouyang P, Lu T, He X, et al. Biomechanical comparison of integrated fixation cage versus anterior cervical plate and cage in anterior cervical corpectomy and fusion (ACCF): a finite element analysis. Med Sci Monit. 2019;25:1489\u201398.","journal-title":"Med Sci Monit"},{"issue":"7","key":"4539_CR24","doi-asserted-by":"publisher","first-page":"E375","DOI":"10.1097\/BRS.0000000000000768","volume":"40","author":"M Scholz","year":"2015","unstructured":"Scholz M, Schleicher P, Pabst S, et al. A zero-profile anchored spacer in multilevel cervical anterior interbody fusion: biomechanical comparison to established fixation techniques. Spine (Phila Pa 1976). 2015;40(7):E375-380.","journal-title":"Spine (Phila Pa 1976)"},{"issue":"5","key":"4539_CR25","doi-asserted-by":"publisher","first-page":"574","DOI":"10.3340\/jkns.2018.0090","volume":"61","author":"TH Kim","year":"2018","unstructured":"Kim TH, Kim DH, Kim KH, et al. Can the zero-profile implant be used for anterior cervical discectomy and fusion in traumatic subaxial disc injury? A preliminary retrospective study. J Korean Neurosurg Soc. 2018;61(5):574\u201381.","journal-title":"J Korean Neurosurg Soc"},{"issue":"7","key":"4539_CR26","doi-asserted-by":"publisher","first-page":"557","DOI":"10.2106\/JBJS.M.00167","volume":"96","author":"KS Song","year":"2014","unstructured":"Song KS, Piyaskulkaew C, Chuntarapas T, et al. Dynamic radiographic criteria for detecting pseudarthrosis following anterior cervical arthrodesis. J Bone Jt Surg Am. 2014;96(7):557\u201363.","journal-title":"J Bone Jt Surg Am"},{"issue":"1","key":"4539_CR27","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1001\/jama.1958.02990010025006","volume":"166","author":"GL Odom","year":"1958","unstructured":"Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc. 1958;166(1):23\u20138.","journal-title":"J Am Med Assoc"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04539-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-024-04539-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-024-04539-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T08:06:21Z","timestamp":1704960381000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-024-04539-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,11]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4539"],"URL":"https:\/\/doi.org\/10.1186\/s13018-024-04539-9","relation":{},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,11]]},"assertion":[{"value":"13 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Shanghai East Hospital Ethics Committee (approval number EC. D (BG). 016. 02. 1) and obtained the informed consents of the participants or their legal representatives. All human experiments followed the Helsinki Guidelines.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Consents for publication were obtained from all participants that data are included in this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declared no competing financial interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"51"}}