{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:26:54Z","timestamp":1787761614638,"version":"build-2784847793"},"reference-count":19,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Stand-alone (SA) zero-profile implants are an alternative to cervical plating (CP) in anterior cervical discectomy and fusion (ACDF). In this study, we investigate differences in surgical outcomes between SA and CP in ACDF. We conducted a retrospective analysis of 166 patients with myelopathy and\/or radiculopathy who had ACDF with SA or CP from Jan 2013\u2013Dec 2016. We measured surgical outcomes including Bazaz dysphagia score at 3 months, Nurick grade at last follow-up, and length of hospital stay. 166 patients (92F\/74M) were reviewed. 92 presented with radiculopathy (55%), 37 with myelopathy (22%), and 37 with myeloradiculopathy (22%). The average operative time with CP was longer than SA (194 \u00b1 69 vs. 126 \u00b1 46 min) (p &lt; 0.001), as was the average length of hospital stay (2.1 \u00b1 2 vs. 1.5 \u00b1 1 days) (p = 0.006). At 3 months, 82 patients (49.4%) had a follow-up for dysphagia, with 3 patients reporting mild dysphagia and none reporting moderate or severe dysphagia. Nurick grade at last follow-up for the myelopathy and myeloradiculopathy cohorts improved in 63 patients (85%). Prolonged length of stay was associated with reduced odds of having an optimal outcome by 0.50 (CI = 0.35\u20130.85, p = 0.003). Overall, we demonstrate that there is no significant difference in neurological outcome or rates of dysphagia between SA and CP, and that both lead to overall improvement of symptoms based on Nurick grading. However, we also show that the SA group has shorter length of hospital stay and operative time compared to CP.<\/jats:p>","DOI":"10.3390\/jcm10143076","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T21:56:37Z","timestamp":1626126997000},"page":"3076","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Clinical Outcomes between Stand-Alone Zero-Profile Spacers and Cervical Plate with Cage Fixation for Anterior Cervical Discectomy and Fusion: A Retrospective Analysis of 166 Patients"],"prefix":"10.3390","volume":"10","author":[{"given":"Samuel","family":"Sommaruga","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"},{"name":"Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquin","family":"Camara-Quintana","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kishan","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4965-3059","authenticated-orcid":false,"given":"Aria","family":"Nouri","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"},{"name":"Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Tessitore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Granit","family":"Molliqaj","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreyas","family":"Panchagnula","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0515, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Virojanapa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fjodor","family":"Melnikov","sequence":"additional","affiliation":[{"name":"Yale Center for Green Chemistry and Engineering, New Haven, CT 06511, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Kolb","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Schaller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Geneva University Hospital, 1205 Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Abbed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06519, USA"},{"name":"Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0515, 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Eur. Neurosurg. Zent. Neurochir."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1177\/2192568218774576","article-title":"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","volume":"9","author":"Cheung","year":"2018","journal-title":"Glob. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1007\/s00586-013-3005-0","article-title":"Zero-P: A new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices","volume":"22","author":"Barbagallo","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1227\/01.NEU.0000215399.67006.05","article-title":"Anterior cervical approach for the treatment of cervical myelopathy","volume":"60","author":"Matz","year":"2007","journal-title":"Neurosurgery"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1053\/j.semss.2015.11.002","article-title":"Anterior cervical discectomy and fusion: Surgical indications and outcomes","volume":"28","author":"Bible","year":"2016","journal-title":"Semin. Spine Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.clineuro.2016.03.010","article-title":"Comparative analysis of clinical outcomes between zero-profile implant and cages with plate fixation in treating multilevel cervical spondilotic myelopathy: A three-year follow-up","volume":"144","author":"Chen","year":"2016","journal-title":"Clin. Neurol. 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Spine J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/2192568220906173","article-title":"Degenerative Cervical Disorder\u2014Stand-alone Cage Versus Cage and Cervical Plate: A Systematic Review","volume":"11","author":"Boer","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.spinee.2004.06.022","article-title":"Surgical treatment of dysphagia after anterior cervical interbody fusion","volume":"5","author":"Fogel","year":"2005","journal-title":"Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/BSD.0b013e318274148e","article-title":"Comparative Analysis of 3 Different Construct Systems for Single-level Anterior Cervical Discectomy and Fusion","volume":"26","author":"Lee","year":"2013","journal-title":"J. Spinal Disord. 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