The effectivity of Zero-Profile in treating Single-Level Traumatic Cervical Disc Herniation: A 3- year follow-up Retrospective Cohort Study

The effectivity of Zero-Profile in treating Single-Level Traumatic Cervical Disc Herniation: A 3- year follow-up Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effectivity of Zero-Profile in treating Single-Level Traumatic Cervical Disc Herniation: A 3- year follow-up Retrospective Cohort Study Guang bing Qin, Wen jie Zhao, Zhuo Nong, zhaojie Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5501555/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aims to compare the mid-term efficacy and safety of anterior cervical discectomy and fusion (ACDF) using the Zero-Profile device versus a cage-and-plate construct in treating single-level traumatic cervical disc herniation. Background： While the Zero-Profile device demonstrates comparable functional and radiological outcomes to the cage-and-plate system in single- and multi-level ACDF for cervical degenerative disc diseases, and reduces complication rates, particularly dysphagia, its suitability for single-level symptomatic traumatic cervical disc herniation remains unclear. Methods: Between August 2020 and August 2023, 50 patients with symptomatic traumatic cervical disc herniation underwent ACDF using either the Zero-Profile device (Group ZP) or the cage-and-plate system (Group CP). Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) scores, Visual Analogue Scale (VAS) scores, Hospital Anxiety and Depression Scale (HADS) scores, radiological outcomes, and complications, were evaluated and compared. Results: All procedures were successfully completed. Both groups demonstrated significant postoperative improvements in JOA, NDI, VAS scores, and cervical lordosis, with no significant differences between groups at any follow-up interval. Fusion and cage subsidence rates were also comparable. Notably, dysphagia rates immediately postoperatively, at 1 week, and at 1 month were lower in Group ZP (14.8%, 11.1%, and 3.7%) compared to Group CP (21.7%, 17.4%, and 13.0%) (P =0.79, 0.82 and 0.49). All patients achieved solid fusion, and no cases of dysphagia were observed at the final follow-up. In terms of HADS scores, no significant differences were observed between the two groups. Conclusions: ACDF using the Zero-Profile device provides comparable surgical outcomes to the cage-and-plate system for single-level traumatic cervical disc herniation while potentially reducing early postoperative dysphagia rates. Thus, it represents an effective and reliable treatment option for this condition. Anterior cervical discectomy and fusion Traumatic cervical disc herniation Zero-Profile Fusion Dysphagia Subsidence Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION Cervical spine trauma, ranging from minor sprains to catastrophic spinal cord injuries, is a common issue among adults¹. Most patients experience minor neck trauma during sports activities or road traffic accidents. Symptomatic traumatic cervical disc herniation without adjacent fractures or dislocations is rare, accounting for only 3% of cervical spine injury cases and 0.08% of all trauma patients². A herniated cervical disc can further compress the spinal cord, increasing the risk of neurological deterioration during conservative treatment 3 , 4 . Clinical manifestations typically include incomplete or complete quadriplegia, with or without spinal cord compression. The goal of surgical treatment is to remove the herniated and damaged disc, prevent further functional loss, and restore spinal stability 5 . Anterior cervical discectomy and fusion (ACDF) is widely regarded as the gold-standard procedure for managing symptomatic traumatic cervical disc herniation 1 , 6 . ACDF not only removes the damaged disc and alleviates spinal cord compression but also provides immediate biomechanical stability using a plate and cage. Incorporating an anterior plate in ACDF surgery can reduce cage subsidence, enhance fusion rates, improve cervical sagittal alignment, and maintain cervical stability⁷ , ⁸. However, the use of an anterior cervical plate is linked to complications such as dysphagia, soft tissue injury, and a higher incidence of adjacent segment disease 8 – 10 . Recently, the Zero-Profile device was developed to minimize potential complications while preserving the advantages of the traditional interbody cage with a plate¹¹. Previous studies have shown that the Zero-Profile device, when used in single- and multi-level ACDF, provides comparable efficacy in improving functional and radiologic outcomes while reducing complication rates, particularly dysphagia 12 – 14 . The suitability of the Zero-Profile device for single-level symptomatic traumatic cervical disc herniation in ACDF remains unclear. Limited studies have investigated the efficacy of the Zero-Profile device in patients with traumatic cervical disc herniation. T This study aimed to evaluate the surgical parameters, clinical outcomes, and radiological results of single-level symptomatic traumatic cervical disc herniation patients treated with ACDF using the Zero-Profile device. METHODS Study Design and Patient Population This study was a retrospective cohort study approved by the Institutional Ethics Committee of the Affiliated Liutie Central Hospital of Guangxi Medical University. From August 2020 to August 2023, a total of 57 patients with single-level symptomatic traumatic cervical disc herniation who underwent ACDF with either a Zero-Profile device or a cage and plate were enrolled in the study. Written informed consent was obtained from all patients prior to participation in the study. All patients underwent preoperative assessments, including radiography (anteroposterior and lateral), magnetic resonance imaging (MRI), and multiplanar reconstructed computed tomography (CT). Inclusion criteria were: (1) diagnosis of single-level traumatic cervical disc herniation treated with ACDF using a Zero-Profile device or a cage and plate, (2) surgical levels from C3-C4 to C6-C7, and (3) follow-up 36 months. Exclusion criteria included: (1) significant segmental instability, (2) need for posterior surgery, (3) bony fractures, (4) metabolic bone diseases, (5) active infections or uncorrectable bleeding disorders, and (6) severe comorbidities in the heart, liver, kidney, or lung that rendered surgery intolerable, (7) participants with missing data. More details were shown in Fig. 1 . Finally,50 patients were included in the data analysis. Based on the surgical method, the remaining 50 patients were divided into two groups. A total of 27 patients who underwent ACDF with a Zero-Profile device were categorized as Group ZP. Meanwhile, 23 patients who underwent ACDF using a cage and anterior plate were assigned to Group CP. Surgical Management All surgeries were performed using the anterior Smith-Robinson approach by an experienced spinal surgeon from our department, as previously described¹². After general anesthesia, patients underwent routine surgery in the supine position with mild neck hyperextension. A right-sided transverse incision was made to expose the target segment. Once the appropriate surgical level was confirmed and exposed, a Caspar cervical distractor was applied to the adjacent vertebral bodies. Following complete decompression and endplate preparation, a trial spacer was used to determine the optimal shape and size of the implant. For Group ZP, a suitable Zero-Profile device filled with excised local osteophytes and demineralized bone matrix was inserted into the prepared target space, and the implant was secured with four screws cranially and caudally. For Group CP, an appropriate interbody cage combined with a cervical plate and screws was implanted, following the method we previously described¹². After releasing the Caspar distractor, a manual pullout test was performed to verify segmental stability. All patients were immobilized with a Philadelphia collar for one month postoperatively. Clinical Evaluation Patient data, including age, gender, BMI, and histories of diabetes, hypertension, coronary artery disease, smoking, and alcohol consumption, were collected on the day of admission. Age was calculated by subtracting the patient's date of birth from the admission date. Histories of diabetes, hypertension, coronary artery disease, smoking, and alcohol consumption were collected through questionnaire interviews. Histories of diabetes, hypertension, and coronary artery disease were defined as previous diagnoses confirmed by qualified medical institutions. Histories of diabetes, hypertension, and coronary artery disease were defined as previous diagnoses confirmed by qualified medical institutions. Alcohol consumption history was defined as consuming alcohol more than once per month within the past year. All patients underwent follow-up at 3 months and the final postoperative evaluation for clinical and radiological assessment after discharge. Demographic data and perioperative details, such as operative time, intraoperative blood loss, and intraoperative/postoperative complications, were documented. Clinical outcomes were assessed using the visual analogue scale (VAS), the Neck Disability Index (NDI) score, Hospital Anxiety and Depression scales (HADS) and the Japanese Orthopaedic Association (JOA) score. The incidence of dysphagia was assessed immediately after surgery, as well as at 1 week, 1 month, and 3 months postoperatively, based on the criteria defined by Bazaz et al 15 . Radiological Evaluation The radiological evaluation was performed in a blinded manner by two independent surgeons. Standard anterior-posterior and lateral radiographs were obtained at 1 month, 3 months, and the final follow-up postoperatively, and measurements were conducted by two independent radiologists. Cervical lordosis was measured using the Cobb angle method, defined as the angle between a line parallel to the upper endplate of the C3 vertebral body and a line parallel to the lower endplate of the C7 vertebral body on standing lateral radiographs. Fusion was evaluated using static and flexion-extension lateral cervical radiographs. Solid fusion was defined based on the following criteria 13 – 16 : (1) the presence of continuous bridging bony trabeculae across the intervertebral space, (2) angular motion of less than 2°at the fused segments on flexion-extension radiographs, and (3) the absence of a radiolucent gap between the cage and endplates. Radiographic subsidence was defined as a reduction in anterior or posterior intervertebral disc height exceeding 2 mm 17 . Adjacent segment degeneration (ASD) was evaluated using lateral plain radiographs at the final follow-up 18 . Radiologic findings indicative of ASD included new or enlarged anterior osteophyte formation, increased narrowing of the intervertebral space, and calcification of the anterior longitudinal ligament. Statistical Analysis All analyses were conducted using SPSS software (version 23.0, Chicago, IL, USA). Independent sample t-tests were used to compare surgical parameters, clinical outcomes, and radiographic parameters between groups. Paired t-tests were applied for comparisons between preoperative and postoperative values. The differences in dysphagia incidence and cage subsidence rates between the two groups were evaluated using the Chi-square test. Statistical significance was defined as a P-value of less than 0.05. RESULTS Baseline The mean age of the ZP group was 46.4 years, while that of the CP group was 50.3 years. Among the included participants, 55.5% of the ZP group were female, compared to 69.6% in the CP group. The average surgical duration was 78.1 minutes in the ZP group and 84.6 minutes in the CP group. All baseline characteristics showed no significant differences between the two groups. Detailed information was presented in Table 1. Clinical Outcomes The JOA, NDI, and VAS scores for neck and arm pain demonstrated significant postoperative improvement compared to preoperative values in both groups (P 0.05; Table 2). Additionally, no significant differences in clinical outcomes were identified between the two groups at any follow-up time point. Radiological Outcomes Cervical lordosis significantly improved in Group ZP from 13.2 ± 8.0° preoperatively to 18.6 ± 7.9° at 3 months and 20.1 ± 8.9° at the final follow-up. In Group CP, it improved from 11.6 ± 7.4° preoperatively to 17.3 ± 7.3° at 3 months and 17.2 ± 7.4° at the final follow-up (Figures2 A3-B3 and Table 3). No significant differences in cervical lordosis were observed between the two groups at any follow-up time point (P > 0.05; Table 3). At 3 months postoperatively, the fusion rate was 81.5% (22/27) in Group ZP and 87.0% (20/23) in Group CP, with no statistically significant difference (P > 0.05; Table 3). All patients achieved solid fusion by the final follow-up. All patients tolerated the procedure well, with no instances of implant failure observed during the follow-up period. According to the Bazaz criteria, the rates of dysphagia immediately postoperatively, at 1 week, and at 1 month in Group ZP were 14.8%, 11.1%, and 3.7%, respectively, which were lower than those in Group CP (21.7%, 17.4%, and 13.0%) (P > 0.05; Table 3). By 3 months postoperatively, none of the patients reported dysphagia. Additionally, 3 patients in Group ZP and 2 patients in Group CP reported cage subsidence at 1 month postoperatively (P > 0.05; Table 3). These patients were instructed to wear a Philadelphia collar for an additional 1–2 months, and by 3 months postoperatively, none reported cage subsidence. At the final follow-up, the incidence of ASD was 3.7% (1/27) in Group ZP and 8.7% (2/23) in Group CP; however, the difference was not statistically significant (P > 0.05; Table 3). Fortunately, no patients exhibited clinical symptoms related to ASD. DISCUSSION Traumatic cervical disc herniation is a relatively rare injury pattern. The primary goals of surgical treatment are to prevent further spinal cord injury, relieve compression on the nerve roots and spinal cord, restore cervical lordosis, and reestablish spinal stability 5 . Anterior cervical discectomy and fusion (ACDF) has become the gold standard for treating degenerative cervical disc disease, offering direct neural decompression and spinal stability reconstruction 19 . ACDF, with or without posterior fixation, has been shown to be a safe and effective technique for treating traumatic cervical injuries 1 , 6 . In this study, ACDF was applied to carefully selected patients without bony fractures, significant segmental instability, or kyphotic deformity. Satisfactory clinical outcomes were achieved in nearly all patients in both groups. Although cage subsidence was observed in Group ZP (3/27) and Group CP (2/23) at 1 month postoperatively, two of these patients were diagnosed with osteoporosis. We hypothesized that osteoporosis might contribute to cage subsidence. These patients were instructed to wear a Philadelphia collar for an additional 1–2 months and receive anti-osteoporosis treatment. By 3 months postoperatively, none of these patients reported cage subsidence, and neither interbody fusion nor clinical outcomes were affected. Therefore, ACDF can be successfully applied to cases of traumatic cervical disc herniation without bony involvement. The Zero-Profile device is a novel cervical integrated intervertebral fusion device, composed of a small titanium alloy plate, a polyether-ether-ketone (PEEK) cage, and four screws for fixation into the vertebral body. The safety and efficacy of the Zero-Profile device in ACDF have been validated in prior studies 13 , 20 , 21 . The Zero-Profile device has also been successfully utilized in single-level ACDF for patients with osteoporosis, as we previously reported 22 . Prior studies have shown that using the Zero-Profile device in ACDF achieves similar radiological fusion rates and clinical outcomes compared to anterior plate and cage systems, while significantly reducing complications such as dysphagia and adjacent segment disease (ASD) 20 , 21 , 23 . The Zero-Profile device has been recognized as an effective fusion method for ACDF in managing single-level and multi-level cervical degenerative disc disease 11 , 22 , 24 , 25 . In this study, we confirmed that ACDF with the Zero-Profile device is a safe and effective treatment option for patients with single-level traumatic cervical disc herniation. In this study, significant improvements in cervical lordosis, JOA, NDI, and VAS scores were observed in all patients from both groups at the final follow-up. Furthermore, all patients achieved solid bony fusion at the final follow-up. Implant subsidence is a common complication in ACDF using stand-alone cages. Subsidence has been reported to typically occur within 3 months postoperatively, with rates ranging from 9.3–62.5% 25–28 . In this study, the cage subsidence rate was 11.1% in Group ZP and 8.6% in Group CP, both falling within the range reported in prior studies. No significant differences in cage subsidence were observed between the two groups. Igarashi H et al. reported that greater cage height is associated with an increased risk of subsidence in ACDF 29 . Park JY et al. identified cage positioning as a significant risk factor for subsidence in ACDF, noting that cages positioned within 3 mm of the anterior vertebral margin had a lower incidence of subsidence 30 . While prior studies have indicated that cage subsidence does not significantly impact clinical outcomes, 26 , 31 long-term follow-up evaluation remains necessary. Although three cases of cage subsidence were observed in Group ZP, these patients still demonstrated satisfactory clinical outcomes and bony fusion at the final follow-up. Wu et al. reported that in long-term studies, improvements in cervical lordosis are more significant than the effects of cage subsidence 31 . Multiple studies have confirmed that the maintenance of cervical lordosis is closely associated with clinical outcomes 32 ,33 . In the normal cervical spine, axial load is primarily distributed along the posterior column in the upright neutral position 34 . As cervical lordosis diminishes, axial load shifts anteriorly, increasing the risk of implant failure, adjacent segment disease (ASD), and even cervical kyphosis 8 ,35 . Additionally, inadequate restoration of cervical lordosis after ACDF can lead to neck pain, shoulder pain, cervical instability, spinal cord compression, and poor functional recovery 33,35 . In this study, cervical lordosis significantly improved and was maintained over time in all patients at the final follow-up. Therefore, ACDF with the Zero-Profile device achieves improvements in cervical lordosis comparable to those achieved with cage-and-plate systems. Achieving solid interbody bony fusion is a primary goal of ACDF surgery, and Kaiser MG et al. reported that bony fusion failure is associated with poor clinical outcomes 36 . Studies have shown that solid bony fusion can prevent postoperative kyphotic deformity and associated foraminal stenosis 37, 38 . A systematic literature review reported that the bony fusion rate was 91.4% in 3,971 ACDF patients treated with cage-and-plate systems, and 96.6% in 499 patients treated with cages featuring attached screws (no plate) 39 . In our study, there was no statistically significant difference in the fusion rate between the two groups at 3 months postoperatively. All patients achieved solid bony fusion by the final follow-up. Consequently, the Zero-Profile device achieves bone fusion rates comparable to cage-and-plate systems in ACDF for single-level traumatic cervical disc herniation. Swallowing dysfunction, or dysphagia, is a major complication associated with ACDF using anterior plate fixation. Previous studies have reported that the incidence of dysphagia following anterior cervical fusion with plate ranges from 1–62% 9, 40, 41 . Dysphagia-related symptoms may be attributed to postoperative hematoma, esophageal injury, soft-tissue edema, and adhesions around the implanted cervical plate 8 . A correlation between plate thickness and the rate of dysphagia has been identified 42 . The Zero-Profile device can be inserted directly into the intervertebral space, minimizing stimulation of the esophagus and other pre-vertebral soft tissues 9 , 20 . In this study, the incidence of postoperative dysphagia in Group ZP was lower than in Group CP at immediate postoperative, 1 week, and 1 month time points, although the difference was not statistically significant. This may be due to the small sample size and the inclusion of only single-segment cases. Therefore, the use of the Zero-Profile device in ACDF may reduce the incidence of early postoperative dysphagia, but this requires confirmation in larger studies and multi-segment cases. Adjacent segment disease (ASD) is another complication associated with ACDF using anterior plate fixation, and its exact pathophysiologic mechanism remains unclear 8 , 16 , 20 . Some researchers suggest that ACDF may alter the natural progression of cervical spondylosis, with the plate potentially increasing motion and intradiscal pressure at untreated levels adjacent to the fused segments 43 . Additionally, an anterior plate positioned too close to the adjacent disc can contribute to adjacent level disc degeneration, while maintaining a distance of < 5 mm between the plate and cage may reduce the incidence of ASD 18 . In this study, the incidence of ASD was 3.7% in Group ZP and 8.7% in Group CP, with no statistically significant difference between the two groups. However, long-term studies with larger patient cohorts are needed to determine whether the Zero-Profile device can reduce the incidence of ASD. This study, however, has several limitations. Firstly, it is a single-center retrospective cohort study. Additionally, the sample size was relatively small. Further multicenter, prospective, randomized studies with larger patient samples are required to validate these findings. Furthermore, this study included only single-level traumatic cervical disc herniation cases, and additional research is needed to evaluate whether multi-level segments might influence complications or clinical outcomes. CONCLUSION ACDF with Zero-Profile device can not only obtain similar surgical effects compared with cage and plate in the treatment of single-level traumatic cervical disc herniation, but may reduce the incidence dysphagia rate at early post operative period. Therefore, ACDF with Zero-Profile can be used as an effective and reliable treatment for single-level traumatic cervical disc herniation. Declarations Data Availability All data during the study are available from the corresponding author by request. Conflicts of Interest The authors declare that no conflict of interest regarding the publication of this paper and the manuscript is approved by all authors for publication. Acknowledgment We thank the patient and investigators involved in this study. Funding Statement This study was supported by the Expression and functional research of LRP5 in osteosarcoma cell lines. Research project funded by the Health Commission of Guangxi Zhuang Autonomous Region（Z-M20221848） AUTHOR’S CONTRIBUTIONS Zhao jie Qin and Guang bing Qin designed the study; Guang bing Qin and Zhao jie Qin searched relevant studies \ analyzed and interpreted the data; Zhuo Nong capture and measure picture data; Guang Bing Qin and Zhao jie Qin wrote the manuscript and Zhao jie Qin approved the final version of the manuscript. Ethics approval and consent to participate The Regional Ethics Committee of Liu Tie Center Hospital approved the study protocol (Approval ID No 2020–01-12). The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. All methods were performed in accordance with the relevant guidelines of Declaration of Helsinki and the relevant guidelines provided by the Ethics Committee of The Regional Ethics Committee of Liu Tie Center Hospital, and all participants provided signed written informed consents in accordance with the Declaration of Helsinki. CONSENT FOR PUBLICATION Not applicable. References Maroon JC, Bost JW, Petraglia AL, et al. Outcomes after anterior cervical discectomy and fusion in professional athletes. Neurosurgery. 2013;73(1):103-112; discussion 112. Hendey GW, Wolfson AB, Mower WR, et al. Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. 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Smith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29(13):1441-1446. 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):406-409. Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(7):597-608. Wenjie Zhao, Yu Zhang, Man Hu et al. Zero-Profile Versus Cage and Plate in Anterior Cervical Discectomy and Fusion for the Treatment of single- level Traumatic Cervical Disc Herniation: A Minimum of Three-Year Follow-Up Study, 30 November 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-2321739/v1] Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Tables.xlsx AdditionalTables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5501555","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":386100482,"identity":"d99ffc2e-80bb-4b46-a733-f1289e007bef","order_by":0,"name":"Guang bing Qin","email":"","orcid":"","institution":"Affiliated Liutie Centarl Hospital of GuangXi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guang","middleName":"bing","lastName":"Qin","suffix":""},{"id":386100484,"identity":"3d795f1b-2bdc-47e6-995f-5f9c4c883a8e","order_by":1,"name":"Wen jie Zhao","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Wen","middleName":"jie","lastName":"Zhao","suffix":""},{"id":386100486,"identity":"e6e2b4bf-134b-4208-9b39-35013ddd2190","order_by":2,"name":"Zhuo Nong","email":"","orcid":"","institution":"Affiliated Liutie Centarl Hospital of GuangXi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhuo","middleName":"","lastName":"Nong","suffix":""},{"id":386100487,"identity":"3669fa3b-aaba-464a-8a90-ab300337a845","order_by":3,"name":"zhaojie Qin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDACZjBiYGZjYGx8+KFCQk6eBC3MzcYSZyyMDRuIswgE2NsEeNsqEhkOEFDOd5z38OeCGht2PvbGNgbJeRIJjA3MDx/dwKNF8jBfgvGMY2nMbDwH2x4UbpPIY2dgMzbOwaPF4DCPQTIP22FmNonEdgPJbRLFjA08bNKEtBzm+QfUIv+wTYJ3jkRiwwHCWgybedtAtjACtTQQoUXyMI8xM28fyC+JwEA+JmFs2EzAL3znzxh/5vlmkyzffvzhww81dXLy7M0PH+PTAouFZIQIMz7lSFrsCKkbBaNgFIyCEQwAiZtDv0eBGWcAAAAASUVORK5CYII=","orcid":"","institution":"The People's Hospital of He Chi","correspondingAuthor":true,"prefix":"","firstName":"zhaojie","middleName":"","lastName":"Qin","suffix":""}],"badges":[],"createdAt":"2024-11-22 04:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5501555/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5501555/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71894572,"identity":"98db587d-0fbb-4349-964c-0f65f891455a","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":31410,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/45534236e3e557c985302119.png"},{"id":71894574,"identity":"d814fc50-1653-453f-854a-1ed53a4191c3","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":244911,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative lateral radiograph (A1), computed tomography (B1) and T2-weighted magnetic resonance imaging (C1) in Group ZP (Zero-Profile device) showing cervical disc herniation with spinal cord compression but without adjacent vertebra fracture at C5-C6 level. Preoperative lateral radiograph (A2), computed tomography (B2) and T2-weighted magnetic resonance imaging (C2) in Group CP (cage and plate) showing cervical disc herniation with spinal cord compression but without adjacent vertebra fracture at C6-C7 level.\u003cstrong\u003e \u003c/strong\u003eLateral radiographs of the cervical spine in Group ZP (Zero-Profile device) at preoperative (A3), 3 months postoperatively (B3), and final follow-up (C3) showing improvement of cervical lordosis and solid fusion.\u003cstrong\u003e \u003c/strong\u003eLateral radiographs of the cervical spine in Group CP (cage and plate) at preoperative (A4), 3 months postoperatively (B4), and final follow-up (C4) showing improvement of cervical lordosis and solid fusion.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/3eaa2c5a0339a1e5caf7932f.png"},{"id":71894585,"identity":"52fb1581-c5e3-4f24-9a3e-db0b315fcb30","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":382517,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure. 1\u003c/strong\u003e Preoperative lateral radiograph (A), computed tomography (B) and T2-weighted magnetic resonance imaging (C) in Group ZP (Zero-Profile device) showing cervical disc herniation with spinal cord compression but without adjacent vertebra fracture at C5-C6 level.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/89da07fc2deb5dbdaafb10de.png"},{"id":71894575,"identity":"0020e39b-a4fa-451e-8553-c9cf62caa3a2","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":365631,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure. 2\u003c/strong\u003e Preoperative lateral radiograph (A), computed tomography (B) and T2-weighted magnetic resonance imaging (C) in Group CP (cage and plate) showing cervical disc herniation with spinal cord compression but without adjacent vertebra fracture at C6-C7 level.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/3153a1253ce37808a8d29f3c.png"},{"id":71894579,"identity":"fff27d5e-87f3-4dcf-9888-d894cf1497ae","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":356622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure. 3 \u003c/strong\u003eLateral radiographs of the cervical spine in Group ZP (Zero-Profile device) at preoperative (A), 3 months postoperatively (B), and final follow-up (C) showing improvement of cervical lordosis and solid fusion.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/b61d30cfeae38be591d1c3d8.png"},{"id":71898163,"identity":"49d5d100-301d-4198-8e95-2d5be5073146","added_by":"auto","created_at":"2024-12-19 13:59:36","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":308906,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure. 4 \u003c/strong\u003eLateral radiographs of the cervical spine in Group CP (cage and plate) at preoperative (A), 3 months postoperatively (B), and final follow-up (C) showing improvement of cervical lordosis and solid fusion.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/b12fd77406ddd4d6f84e0343.png"},{"id":106994206,"identity":"a620616b-b2c0-44ad-bbef-de82ec4bb506","added_by":"auto","created_at":"2026-04-15 15:06:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2768637,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/9d2710bc-f191-401d-a931-f1aa3f4db0f4.pdf"},{"id":71894586,"identity":"73a8dba3-201e-4e3f-9d29-5d669607e022","added_by":"auto","created_at":"2024-12-19 13:35:36","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15373,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/2f6e2ab24bf78311f2eaea6f.xlsx"},{"id":71894570,"identity":"c3407c60-a8b4-4dd3-b63d-5aee239f99b0","added_by":"auto","created_at":"2024-12-19 13:35:35","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":23640,"visible":true,"origin":"","legend":"","description":"","filename":"AdditionalTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5501555/v1/6ab078739402220fb149ca49.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effectivity of Zero-Profile in treating Single-Level Traumatic Cervical Disc Herniation: A 3- year follow-up Retrospective Cohort Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCervical spine trauma, ranging from minor sprains to catastrophic spinal cord injuries, is a common issue among adults\u0026sup1;. Most patients experience minor neck trauma during sports activities or road traffic accidents. Symptomatic traumatic cervical disc herniation without adjacent fractures or dislocations is rare, accounting for only 3% of cervical spine injury cases and 0.08% of all trauma patients\u0026sup2;. A herniated cervical disc can further compress the spinal cord, increasing the risk of neurological deterioration during conservative treatment\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Clinical manifestations typically include incomplete or complete quadriplegia, with or without spinal cord compression. The goal of surgical treatment is to remove the herniated and damaged disc, prevent further functional loss, and restore spinal stability\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Anterior cervical discectomy and fusion (ACDF) is widely regarded as the gold-standard procedure for managing symptomatic traumatic cervical disc herniation\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. ACDF not only removes the damaged disc and alleviates spinal cord compression but also provides immediate biomechanical stability using a plate and cage.\u003c/p\u003e \u003cp\u003eIncorporating an anterior plate in ACDF surgery can reduce cage subsidence, enhance fusion rates, improve cervical sagittal alignment, and maintain cervical stability⁷\u003csup\u003e,\u003c/sup\u003e⁸. However, the use of an anterior cervical plate is linked to complications such as dysphagia, soft tissue injury, and a higher incidence of adjacent segment disease\u003csup\u003e\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Recently, the Zero-Profile device was developed to minimize potential complications while preserving the advantages of the traditional interbody cage with a plate\u0026sup1;\u0026sup1;. Previous studies have shown that the Zero-Profile device, when used in single- and multi-level ACDF, provides comparable efficacy in improving functional and radiologic outcomes while reducing complication rates, particularly dysphagia\u003csup\u003e\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe suitability of the Zero-Profile device for single-level symptomatic traumatic cervical disc herniation in ACDF remains unclear. Limited studies have investigated the efficacy of the Zero-Profile device in patients with traumatic cervical disc herniation. T This study aimed to evaluate the surgical parameters, clinical outcomes, and radiological results of single-level symptomatic traumatic cervical disc herniation patients treated with ACDF using the Zero-Profile device.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Patient Population\u003c/h2\u003e \u003cp\u003e This study was a retrospective cohort study approved by the Institutional Ethics Committee of the Affiliated Liutie Central Hospital of Guangxi Medical University. From August 2020 to August 2023, a total of 57 patients with single-level symptomatic traumatic cervical disc herniation who underwent ACDF with either a Zero-Profile device or a cage and plate were enrolled in the study. Written informed consent was obtained from all patients prior to participation in the study. All patients underwent preoperative assessments, including radiography (anteroposterior and lateral), magnetic resonance imaging (MRI), and multiplanar reconstructed computed tomography (CT).\u003c/p\u003e \u003cp\u003eInclusion criteria were: (1) diagnosis of single-level traumatic cervical disc herniation treated with ACDF using a Zero-Profile device or a cage and plate, (2) surgical levels from C3-C4 to C6-C7, and (3) follow-up 36 months. Exclusion criteria included: (1) significant segmental instability, (2) need for posterior surgery, (3) bony fractures, (4) metabolic bone diseases, (5) active infections or uncorrectable bleeding disorders, and (6) severe comorbidities in the heart, liver, kidney, or lung that rendered surgery intolerable, (7) participants with missing data. More details were shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally,50 patients were included in the data analysis. Based on the surgical method, the remaining 50 patients were divided into two groups. A total of 27 patients who underwent ACDF with a Zero-Profile device were categorized as Group ZP. Meanwhile, 23 patients who underwent ACDF using a cage and anterior plate were assigned to Group CP.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurgical Management\u003c/h3\u003e\n\u003cp\u003eAll surgeries were performed using the anterior Smith-Robinson approach by an experienced spinal surgeon from our department, as previously described\u0026sup1;\u0026sup2;. After general anesthesia, patients underwent routine surgery in the supine position with mild neck hyperextension. A right-sided transverse incision was made to expose the target segment. Once the appropriate surgical level was confirmed and exposed, a Caspar cervical distractor was applied to the adjacent vertebral bodies. Following complete decompression and endplate preparation, a trial spacer was used to determine the optimal shape and size of the implant. For Group ZP, a suitable Zero-Profile device filled with excised local osteophytes and demineralized bone matrix was inserted into the prepared target space, and the implant was secured with four screws cranially and caudally. For Group CP, an appropriate interbody cage combined with a cervical plate and screws was implanted, following the method we previously described\u0026sup1;\u0026sup2;. After releasing the Caspar distractor, a manual pullout test was performed to verify segmental stability. All patients were immobilized with a Philadelphia collar for one month postoperatively.\u003c/p\u003e\n\u003ch3\u003eClinical Evaluation\u003c/h3\u003e\n\u003cp\u003ePatient data, including age, gender, BMI, and histories of diabetes, hypertension, coronary artery disease, smoking, and alcohol consumption, were collected on the day of admission. Age was calculated by subtracting the patient's date of birth from the admission date. Histories of diabetes, hypertension, coronary artery disease, smoking, and alcohol consumption were collected through questionnaire interviews. Histories of diabetes, hypertension, and coronary artery disease were defined as previous diagnoses confirmed by qualified medical institutions. Histories of diabetes, hypertension, and coronary artery disease were defined as previous diagnoses confirmed by qualified medical institutions. Alcohol consumption history was defined as consuming alcohol more than once per month within the past year. All patients underwent follow-up at 3 months and the final postoperative evaluation for clinical and radiological assessment after discharge. Demographic data and perioperative details, such as operative time, intraoperative blood loss, and intraoperative/postoperative complications, were documented. Clinical outcomes were assessed using the visual analogue scale (VAS), the Neck Disability Index (NDI) score, Hospital Anxiety and Depression scales (HADS) and the Japanese Orthopaedic Association (JOA) score. The incidence of dysphagia was assessed immediately after surgery, as well as at 1 week, 1 month, and 3 months postoperatively, based on the criteria defined by Bazaz et al\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eRadiological Evaluation\u003c/h3\u003e\n\u003cp\u003eThe radiological evaluation was performed in a blinded manner by two independent surgeons. Standard anterior-posterior and lateral radiographs were obtained at 1 month, 3 months, and the final follow-up postoperatively, and measurements were conducted by two independent radiologists. Cervical lordosis was measured using the Cobb angle method, defined as the angle between a line parallel to the upper endplate of the C3 vertebral body and a line parallel to the lower endplate of the C7 vertebral body on standing lateral radiographs. Fusion was evaluated using static and flexion-extension lateral cervical radiographs. Solid fusion was defined based on the following criteria\u003csup\u003e\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e: (1) the presence of continuous bridging bony trabeculae across the intervertebral space, (2) angular motion of less than 2\u0026deg;at the fused segments on flexion-extension radiographs, and (3) the absence of a radiolucent gap between the cage and endplates. Radiographic subsidence was defined as a reduction in anterior or posterior intervertebral disc height exceeding 2 mm\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. Adjacent segment degeneration (ASD) was evaluated using lateral plain radiographs at the final follow-up\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Radiologic findings indicative of ASD included new or enlarged anterior osteophyte formation, increased narrowing of the intervertebral space, and calcification of the anterior longitudinal ligament.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAll analyses were conducted using SPSS software (version 23.0, Chicago, IL, USA). Independent sample t-tests were used to compare surgical parameters, clinical outcomes, and radiographic parameters between groups. Paired t-tests were applied for comparisons between preoperative and postoperative values. The differences in dysphagia incidence and cage subsidence rates between the two groups were evaluated using the Chi-square test. Statistical significance was defined as a P-value of less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eBaseline\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mean age of the ZP group was 46.4 years, while that of the CP group was 50.3 years. Among the included participants, 55.5% of the ZP group were female, compared to 69.6% in the CP group. The average surgical duration was 78.1 minutes in the ZP group and 84.6 minutes in the CP group. All baseline characteristics showed no significant differences between the two groups. Detailed information was presented in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe JOA, NDI, and VAS scores for neck and arm pain demonstrated significant postoperative improvement compared to preoperative values in both groups (P \u0026lt; 0.05; Table 2). These improvements were maintained over time, with no statistically significant differences between the postoperative scores and those at the final follow-up (P \u0026gt; 0.05; Table 2). Additionally, no significant differences in clinical outcomes were identified between the two groups at any follow-up time point.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRadiological Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCervical lordosis significantly improved in Group ZP from 13.2 \u0026plusmn; 8.0\u0026deg; preoperatively to 18.6 \u0026plusmn; 7.9\u0026deg; at 3 months and 20.1 \u0026plusmn; 8.9\u0026deg; at the final follow-up. In Group CP, it improved from 11.6 \u0026plusmn; 7.4\u0026deg; preoperatively to 17.3 \u0026plusmn; 7.3\u0026deg; at 3 months and 17.2 \u0026plusmn; 7.4\u0026deg; at the final follow-up (Figures2 A3-B3 and Table 3). No significant differences in cervical lordosis were observed between the two groups at any follow-up time point (P \u0026gt; 0.05; Table 3). At 3 months postoperatively, the fusion rate was 81.5% (22/27) in Group ZP and 87.0% (20/23) in Group CP, with no statistically significant difference (P \u0026gt; 0.05; Table 3). All patients achieved solid fusion by the final follow-up.\u003c/p\u003e\n\u003cp\u003eAll patients tolerated the procedure well, with no instances of implant failure observed during the follow-up period. According to the Bazaz criteria, the rates of dysphagia immediately postoperatively, at 1 week, and at 1 month in Group ZP were 14.8%, 11.1%, and 3.7%, respectively, which were lower than those in Group CP (21.7%, 17.4%, and 13.0%) (P \u0026gt; 0.05; Table 3). By 3 months postoperatively, none of the patients reported dysphagia. Additionally, 3 patients in Group ZP and 2 patients in Group CP reported cage subsidence at 1 month postoperatively (P \u0026gt; 0.05; Table 3). These patients were instructed to wear a Philadelphia collar for an additional 1\u0026ndash;2 months, and by 3 months postoperatively, none reported cage subsidence. At the final follow-up, the incidence of ASD was 3.7% (1/27) in Group ZP and 8.7% (2/23) in Group CP; however, the difference was not statistically significant (P \u0026gt; 0.05; Table 3). Fortunately, no patients exhibited clinical symptoms related to ASD.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTraumatic cervical disc herniation is a relatively rare injury pattern. The primary goals of surgical treatment are to prevent further spinal cord injury, relieve compression on the nerve roots and spinal cord, restore cervical lordosis, and reestablish spinal stability\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Anterior cervical discectomy and fusion (ACDF) has become the gold standard for treating degenerative cervical disc disease, offering direct neural decompression and spinal stability reconstruction\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. ACDF, with or without posterior fixation, has been shown to be a safe and effective technique for treating traumatic cervical injuries\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. In this study, ACDF was applied to carefully selected patients without bony fractures, significant segmental instability, or kyphotic deformity. Satisfactory clinical outcomes were achieved in nearly all patients in both groups. Although cage subsidence was observed in Group ZP (3/27) and Group CP (2/23) at 1 month postoperatively, two of these patients were diagnosed with osteoporosis. We hypothesized that osteoporosis might contribute to cage subsidence. These patients were instructed to wear a Philadelphia collar for an additional 1\u0026ndash;2 months and receive anti-osteoporosis treatment. By 3 months postoperatively, none of these patients reported cage subsidence, and neither interbody fusion nor clinical outcomes were affected. Therefore, ACDF can be successfully applied to cases of traumatic cervical disc herniation without bony involvement.\u003c/p\u003e \u003cp\u003eThe Zero-Profile device is a novel cervical integrated intervertebral fusion device, composed of a small titanium alloy plate, a polyether-ether-ketone (PEEK) cage, and four screws for fixation into the vertebral body. The safety and efficacy of the Zero-Profile device in ACDF have been validated in prior studies\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The Zero-Profile device has also been successfully utilized in single-level ACDF for patients with osteoporosis, as we previously reported\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Prior studies have shown that using the Zero-Profile device in ACDF achieves similar radiological fusion rates and clinical outcomes compared to anterior plate and cage systems, while significantly reducing complications such as dysphagia and adjacent segment disease (ASD) \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. The Zero-Profile device has been recognized as an effective fusion method for ACDF in managing single-level and multi-level cervical degenerative disc disease\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. In this study, we confirmed that ACDF with the Zero-Profile device is a safe and effective treatment option for patients with single-level traumatic cervical disc herniation.\u003c/p\u003e \u003cp\u003eIn this study, significant improvements in cervical lordosis, JOA, NDI, and VAS scores were observed in all patients from both groups at the final follow-up. Furthermore, all patients achieved solid bony fusion at the final follow-up. Implant subsidence is a common complication in ACDF using stand-alone cages. Subsidence has been reported to typically occur within 3 months postoperatively, with rates ranging from 9.3\u0026ndash;62.5%\u003csup\u003e25\u0026ndash;28\u003c/sup\u003e. In this study, the cage subsidence rate was 11.1% in Group ZP and 8.6% in Group CP, both falling within the range reported in prior studies. No significant differences in cage subsidence were observed between the two groups. Igarashi H et al. reported that greater cage height is associated with an increased risk of subsidence in ACDF\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Park JY et al. identified cage positioning as a significant risk factor for subsidence in ACDF, noting that cages positioned within 3 mm of the anterior vertebral margin had a lower incidence of subsidence\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. While prior studies have indicated that cage subsidence does not significantly impact clinical outcomes,\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e long-term follow-up evaluation remains necessary. Although three cases of cage subsidence were observed in Group ZP, these patients still demonstrated satisfactory clinical outcomes and bony fusion at the final follow-up.\u003c/p\u003e \u003cp\u003eWu et al. reported that in long-term studies, improvements in cervical lordosis are more significant than the effects of cage subsidence\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. Multiple studies have confirmed that the maintenance of cervical lordosis is closely associated with clinical outcomes\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,33\u003c/sup\u003e. In the normal cervical spine, axial load is primarily distributed along the posterior column in the upright neutral position\u003csup\u003e34\u003c/sup\u003e. As cervical lordosis diminishes, axial load shifts anteriorly, increasing the risk of implant failure, adjacent segment disease (ASD), and even cervical kyphosis\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,35\u003c/sup\u003e. Additionally, inadequate restoration of cervical lordosis after ACDF can lead to neck pain, shoulder pain, cervical instability, spinal cord compression, and poor functional recovery\u003csup\u003e33,35\u003c/sup\u003e. In this study, cervical lordosis significantly improved and was maintained over time in all patients at the final follow-up. Therefore, ACDF with the Zero-Profile device achieves improvements in cervical lordosis comparable to those achieved with cage-and-plate systems.\u003c/p\u003e \u003cp\u003eAchieving solid interbody bony fusion is a primary goal of ACDF surgery, and Kaiser MG et al. reported that bony fusion failure is associated with poor clinical outcomes\u003csup\u003e36\u003c/sup\u003e. Studies have shown that solid bony fusion can prevent postoperative kyphotic deformity and associated foraminal stenosis\u003csup\u003e37, 38\u003c/sup\u003e. A systematic literature review reported that the bony fusion rate was 91.4% in 3,971 ACDF patients treated with cage-and-plate systems, and 96.6% in 499 patients treated with cages featuring attached screws (no plate) \u003csup\u003e39\u003c/sup\u003e. In our study, there was no statistically significant difference in the fusion rate between the two groups at 3 months postoperatively. All patients achieved solid bony fusion by the final follow-up. Consequently, the Zero-Profile device achieves bone fusion rates comparable to cage-and-plate systems in ACDF for single-level traumatic cervical disc herniation.\u003c/p\u003e \u003cp\u003eSwallowing dysfunction, or dysphagia, is a major complication associated with ACDF using anterior plate fixation. Previous studies have reported that the incidence of dysphagia following anterior cervical fusion with plate ranges from 1\u0026ndash;62%\u003csup\u003e9, 40, 41\u003c/sup\u003e. Dysphagia-related symptoms may be attributed to postoperative hematoma, esophageal injury, soft-tissue edema, and adhesions around the implanted cervical plate\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. A correlation between plate thickness and the rate of dysphagia has been identified\u003csup\u003e42\u003c/sup\u003e. The Zero-Profile device can be inserted directly into the intervertebral space, minimizing stimulation of the esophagus and other pre-vertebral soft tissues\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. In this study, the incidence of postoperative dysphagia in Group ZP was lower than in Group CP at immediate postoperative, 1 week, and 1 month time points, although the difference was not statistically significant. This may be due to the small sample size and the inclusion of only single-segment cases. Therefore, the use of the Zero-Profile device in ACDF may reduce the incidence of early postoperative dysphagia, but this requires confirmation in larger studies and multi-segment cases.\u003c/p\u003e \u003cp\u003eAdjacent segment disease (ASD) is another complication associated with ACDF using anterior plate fixation, and its exact pathophysiologic mechanism remains unclear\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Some researchers suggest that ACDF may alter the natural progression of cervical spondylosis, with the plate potentially increasing motion and intradiscal pressure at untreated levels adjacent to the fused segments\u003csup\u003e43\u003c/sup\u003e. Additionally, an anterior plate positioned too close to the adjacent disc can contribute to adjacent level disc degeneration, while maintaining a distance of \u0026lt;\u0026thinsp;5 mm between the plate and cage may reduce the incidence of ASD\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In this study, the incidence of ASD was 3.7% in Group ZP and 8.7% in Group CP, with no statistically significant difference between the two groups. However, long-term studies with larger patient cohorts are needed to determine whether the Zero-Profile device can reduce the incidence of ASD. This study, however, has several limitations. Firstly, it is a single-center retrospective cohort study. Additionally, the sample size was relatively small. Further multicenter, prospective, randomized studies with larger patient samples are required to validate these findings. Furthermore, this study included only single-level traumatic cervical disc herniation cases, and additional research is needed to evaluate whether multi-level segments might influence complications or clinical outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eACDF with Zero-Profile device can not only obtain similar surgical effects compared with cage and plate in the treatment of single-level traumatic cervical disc herniation, but may reduce the incidence dysphagia rate at early post operative period. Therefore, ACDF with Zero-Profile can be used as an effective and reliable treatment for single-level traumatic cervical disc herniation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data during the study are available from the corresponding author by request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no conflict of interest regarding the publication of this paper and the manuscript is approved by all authors for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the patient and investigators involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the\u0026nbsp;Expression and functional research of LRP5 in osteosarcoma cell lines. Research project funded by the Health Commission of Guangxi Zhuang Autonomous Region（Z-M20221848）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR\u0026rsquo;S CONTRIBUTIONS \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhao jie Qin and Guang bing Qin designed the study; Guang bing Qin and Zhao jie Qin searched relevant studies \\ analyzed and interpreted the data; Zhuo Nong capture and measure picture data; Guang Bing Qin and Zhao jie Qin wrote the manuscript and Zhao jie Qin approved the final version of the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe Regional Ethics Committee of Liu Tie Center Hospital approved the study protocol (Approval ID No 2020\u0026ndash;01-12). The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. All methods were performed in accordance with the relevant guidelines of Declaration of Helsinki and the relevant guidelines provided by the Ethics Committee of The Regional Ethics Committee of Liu Tie Center Hospital, and all participants provided signed written informed consents in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMaroon JC, Bost JW, Petraglia AL, et al. Outcomes after anterior cervical discectomy and fusion in professional athletes. Neurosurgery. 2013;73(1):103-112; discussion 112.\u003c/li\u003e\n\u003cli\u003eHendey GW, Wolfson AB, Mower WR, et al. Spinal cord injury without radiographic abnormality: results of the National Emergency X-Radiography Utilization Study in blunt cervical trauma. J Trauma. 2002;53(1):1-4.\u003c/li\u003e\n\u003cli\u003eAhuja CS, Wilson JR, Nori S, et al. Traumatic spinal cord injury. Nat Rev Dis Primers. 2017;3:17018.\u003c/li\u003e\n\u003cli\u003eJin W, Sun X, Shen K, et al. Recurrent Neurological Deterioration after Conservative Treatment for Acute Traumatic Central Cord Syndrome without Bony Injury: Seventeen Operative Case Reports. J Neurotrauma. 2017;34(21):3051-3057.\u003c/li\u003e\n\u003cli\u003eAebi M. Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J. 2010;19 Suppl 1(Suppl 1):S33-39.\u003c/li\u003e\n\u003cli\u003eSane JC, Hope JMV, Diao S, et al. Early presentation of traumatic cervical disc herniation with neurologic deficit and without an adjacent bone lesion. Int Orthop. 2019;43(4):785-790.\u003c/li\u003e\n\u003cli\u003eChung JY, Kim SK, Jung ST, et al. Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J. 2014;14(10):2290-2298.\u003c/li\u003e\n\u003cli\u003eFountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 2007;32(21):2310-2317.\u003c/li\u003e\n\u003cli\u003eKalb S, Reis MT, Cowperthwaite MC, et al. Dysphagia after anterior cervical spine surgery: incidence and risk factors. World Neurosurg. 2012;77(1):183-187.\u003c/li\u003e\n\u003cli\u003ePitzen TR, Chrobok J, Stulik J, et al. Implant complications, fusion, loss of lordosis, and outcome after anterior cervical plating with dynamic or rigid plates: two-year results of a multi-centric, randomized, controlled study. Spine (Phila Pa 1976). 2009;34(7):641-646.\u003c/li\u003e\n\u003cli\u003eScholz M, Schnake KJ, Pingel A, et al. A new zero-profile implant for stand-alone anterior cervical interbody fusion. Clin Orthop Relat Res. 2011;469(3):666-673.\u003c/li\u003e\n\u003cli\u003eZhang L, Wang J, Tao Y, et al. Outcome Evaluation of Zero-Profile Implant Compared with an Anterior Plate and Cage Used in Anterior Cervical Discectomy and Fusion: A Two-Year Follow-Up Study. Turk Neurosurg. 2016;26(3):416-422.\u003c/li\u003e\n\u003cli\u003eShen Y, Du W, Wang LF, et al. Comparison of Zero-profile Device Versus Plate-and-Cage Implant in the Treatment of Symptomatic Adjacent Segment Disease after Anterior Cervical Discectomy and Fusion: A Minimum 2-Year Follow-Up Study. World Neurosurg. 2018;115:e226-e232.\u003c/li\u003e\n\u003cli\u003eXiao S, Liang Z, Wei W, et al. Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion. Eur Spine J. 2017;26(4):975-984.\u003c/li\u003e\n\u003cli\u003eBazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine (Phila Pa 1976). 2002;27(22):2453-2458.\u003c/li\u003e\n\u003cli\u003eHacker RJ, Cauthen JC, Gilbert TJ, et al. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine (Phila Pa 1976). 2000;25(20):2646-2654; discussion 2655.\u003c/li\u003e\n\u003cli\u003eYun DJ, Lee SJ, Park SJ, et al. Use of a Zero-Profile Device for Contiguous 2-Level Anterior Cervical Diskectomy and Fusion: Comparison with Cage with Plate Construct. World Neurosurg. 2017;97:189-198.\u003c/li\u003e\n\u003cli\u003ePark JB, Cho YS, Riew KD. Development of adjacent-level ossification in patients with an anterior cervical plate. J Bone Joint Surg Am. 2005;87(3):558-563.\u003c/li\u003e\n\u003cli\u003eButtermann GR. Anterior Cervical Discectomy and Fusion Outcomes over 10 Years: A Prospective Study. Spine (Phila Pa 1976). 2018;43(3):207-214.\u003c/li\u003e\n\u003cli\u003eYang H, Chen D, Wang X, et al. Zero-profile integrated plate and spacer device reduces rate of adjacent-level ossification development and dysphagia compared to ACDF with plating and cage system. Arch Orthop Trauma Surg. 2015;135(6):781-787.\u003c/li\u003e\n\u003cli\u003eZhou J, Li J, Lin H, et al. A comparison of a self-locking stand-alone cage and anterior cervical plate for ACDF: Minimum 3-year assessment of radiographic and clinical outcomes. Clin Neurol Neurosurg. 2018;170:73-78.\u003c/li\u003e\n\u003cli\u003eZhang L, Wang J, Feng X, et al. Outcome Evaluation of Zero-Profile Device Used for Single-Level Anterior Cervical Discectomy and Fusion with Osteoporosis Compared without Osteoporosis: A Minimum Three-Year Follow-Up Study. World Neurosurg. 2018 Oct 12:S1878-8750(18)32317-9.\u003c/li\u003e\n\u003cli\u003eLi Z, Zhao Y, Tang J, et al. A comparison of a new zero-profile, stand-alone Fidji cervical cage and anterior cervical plate for single and multilevel ACDF: a minimum 2-year follow-up study. Eur Spine J. 2017;26(4):1129-1139.\u003c/li\u003e\n\u003cli\u003eZhang Z, Li Y, Jiang W. A comparison of zero-profile anchored spacer (ROI-C) and plate fixation in 2-level noncontiguous anterior cervical discectomy and fusion- a retrospective study. BMC Musculoskelet Disord. 2018;19(1):119.\u003c/li\u003e\n\u003cli\u003eChoi MK, Kim SB, Park CK, et al. Comparison of the clinical and radiologic outcomes obtained with single- versus two-level anterior cervical decompression and fusion using stand-alone PEEK cages filled with allograft. Acta Neurochir (Wien). 2016;158(3):481-487.\u003c/li\u003e\n\u003cli\u003eGercek E, Arlet V, Delisle J, et al. Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J. 2003;12(5):513-516.\u003c/li\u003e\n\u003cli\u003eCao L, Chen Q, Jiang LB, et al. Bioabsorbable self-retaining PLA/nano-sized \u0026beta;-TCP cervical spine interbody fusion cage in goat models: an in vivo study. Int J Nanomedicine. 2017;12:7197-7205.\u003c/li\u003e\n\u003cli\u003eSchmieder K, Wolzik-Grossmann M, Pechlivanis I, et al. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine. 2006;4(6):447-453.\u003c/li\u003e\n\u003cli\u003eIgarashi H, Hoshino M, Omori K, et al. Factors Influencing Interbody Cage Subsidence Following Anterior Cervical Discectomy and Fusion. Clin Spine Surg. 2019;32(7):297-302.\u003c/li\u003e\n\u003cli\u003ePark JY, Choi KY, Moon BJ, et al. Subsidence after single-level anterior cervical fusion with a stand-alone cage. J Clin Neurosci. 2016; 33:83-88.\u003c/li\u003e\n\u003cli\u003eWu WJ, Jiang LS, Liang Y, et al. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: a retrospective study. Eur Spine J. 2012;21(7):1374-1382.\u003c/li\u003e\n\u003cli\u003eLi Z, Guo Z, Hou S, et al. Segmental anterior cervical corpectomy and fusion with preservation of middle vertebrae in the surgical management of 4-level cervical spondylotic myelopathy. Eur Spine J. 2014;23(7):1472-1479.\u003c/li\u003e\n\u003cli\u003eVillavicencio AT, Babuska JM, Ashton A, et al. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery. 2011;68(5):1309-1316; discussion 1316.\u003c/li\u003e\n\u003cli\u003ePal GP, Sherk HH. The vertical stability of the cervical spine. Spine (Phila Pa 1976). 1988;13(5):447-449.\u003c/li\u003e\n\u003cli\u003eFerch RD, Shad A, Cadoux-Hudson TA, et al. Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. J Neurosurg. 2004;100(1 Suppl Spine):13-19.\u003c/li\u003e\n\u003cli\u003eKaiser MG, Haid RW, Jr., Subach BR, et al. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. 2002;50(2):229-236; discussion 236-228.\u003c/li\u003e\n\u003cli\u003eThorell W, Cooper J, Hellbusch L, et al. The long-term clinical outcome of patients undergoing anterior cervical discectomy with and without intervertebral bone graft placement. Neurosurgery. 1998;43(2):268-273; discussion 273-264.\u003c/li\u003e\n\u003cli\u003eMurphy MA, Trimble MB, Piedmonte MR, et al. Changes in the cervical foraminal area after anterior discectomy with and without a graft. Neurosurgery. 1994;34(1):93-96.\u003c/li\u003e\n\u003cli\u003eNoordhoek I, Koning MT, Vleggeert-Lankamp CLA. Evaluation of bony fusion after anterior cervical discectomy: a systematic literature review. Eur Spine J. 2019;28(2):386-399.\u003c/li\u003e\n\u003cli\u003eWang ZD, Zhu RF, Yang HL, et al. The application of a zero-profile implant in anterior cervical discectomy and fusion. J Clin Neurosci. 2014;21(3):462-466.\u003c/li\u003e\n\u003cli\u003eSmith-Hammond CA, New KC, Pietrobon R, et al. Prospective analysis of incidence and risk factors of dysphagia in spine surgery patients: comparison of anterior cervical, posterior cervical, and lumbar procedures. Spine (Phila Pa 1976). 2004;29(13):1441-1446.\u003c/li\u003e\n\u003cli\u003eLee 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):406-409.\u003c/li\u003e\n\u003cli\u003eXia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(7):597-608.\u003c/li\u003e\n\u003cli\u003eWenjie Zhao, Yu Zhang, Man Hu et al. Zero-Profile Versus Cage and Plate in Anterior Cervical Discectomy and Fusion for the Treatment of single- level Traumatic Cervical Disc Herniation: A Minimum of Three-Year Follow-Up Study, 30 November 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-2321739/v1]\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anterior cervical discectomy and fusion, Traumatic cervical disc herniation, Zero-Profile, Fusion, Dysphagia, Subsidence","lastPublishedDoi":"10.21203/rs.3.rs-5501555/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5501555/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aims to compare the mid-term efficacy and safety of anterior cervical discectomy and fusion (ACDF) using the Zero-Profile device versus a cage-and-plate construct in treating single-level traumatic cervical disc herniation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground：\u003c/strong\u003eWhile the Zero-Profile device demonstrates comparable functional and radiological outcomes to the cage-and-plate system in single- and multi-level ACDF for cervical degenerative disc diseases, and reduces complication rates, particularly dysphagia, its suitability for single-level symptomatic traumatic cervical disc herniation remains unclear.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Between August 2020 and August 2023, 50 patients with symptomatic traumatic cervical disc herniation underwent ACDF using either the Zero-Profile device (Group ZP) or the cage-and-plate system (Group CP). Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index (NDI) scores, Visual Analogue Scale (VAS) scores, Hospital Anxiety and Depression Scale (HADS) scores, radiological outcomes, and complications, were evaluated and compared.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e All procedures were successfully completed. Both groups demonstrated significant postoperative improvements in JOA, NDI, VAS scores, and cervical lordosis, with no significant differences between groups at any follow-up interval. Fusion and cage subsidence rates were also comparable. Notably, dysphagia rates immediately postoperatively, at 1 week, and at 1 month were lower in Group ZP (14.8%, 11.1%, and 3.7%) compared to Group CP (21.7%, 17.4%, and 13.0%) (P =0.79, 0.82 and 0.49). All patients achieved solid fusion, and no cases of dysphagia were observed at the final follow-up. In terms of HADS scores, no significant differences were observed between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eACDF using the Zero-Profile device provides comparable surgical outcomes to the cage-and-plate system for single-level traumatic cervical disc herniation while potentially reducing early postoperative dysphagia rates. Thus, it represents an effective and reliable treatment option for this condition.\u003c/p\u003e","manuscriptTitle":"The effectivity of Zero-Profile in treating Single-Level Traumatic Cervical Disc Herniation: A 3- year follow-up Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 13:35:30","doi":"10.21203/rs.3.rs-5501555/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd73d564-c31f-45d6-b745-3b64c52e8252","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-12T18:42:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-19 13:35:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5501555","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5501555","identity":"rs-5501555","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}