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Background <p>Plate-cage constructs for contiguous bilevel cervical spondylotic myelopathy (CSM) are effective, but associated with dysphagia and adjacent segment degeneration. Zero-profile variable-angle (Zero-P VA) spacers may reduce these drawbacks, but 3-year radiographic evidence is limited. This study compared 3-year outcomes of Zero-P VA versus plate-cage constructs for contiguous bilevel CSM.</p> Methods <p>Patients undergoing bilevel ACDF for CSM with Zero-P VA (VA group, <i>n</i> = 51) or plate-cage constructs (PC group, <i>n</i> = 58) between 2018 and 2021 (≥ 3-year follow-up) were reviewed. Outcomes included JOA/VAS scores, dysphagia (Bazaz system), and radiographic parameters: intervertebral height (IH), cervical Cobb angle (CCA), segmental Cobb angle (SCA), radiographic adjacent segment degeneration (ASDeg), and fusion rates.</p> Results <p>Neurological improvement was similar between groups (<i>p</i> &gt; 0.05). VA had shorter operation duration (103.4 vs. 116.1&#xa0;min, <i>p</i> &lt; 0.05) and less intraoperative bleeding (78.6 vs. 91.2&#xa0;mL, <i>p</i> &lt; 0.05). Early dysphagia was lower in VA (37.3% vs. 56.9%, <i>p</i> = 0.041). At 3&#xa0;years, superior IH (PC:7.06 vs. VA:6.55&#xa0;mm, <i>p</i> = 0.001) and inferior IH (6.97 vs. 6.14&#xa0;mm, <i>p</i> &lt; 0.001) were better maintained in PC. SCA loss was greater in VA (final SCA: 9.03° vs. 6.58°, <i>p</i> = 0.027). Subsidence rate was higher in VA (10.8% vs. 0.9% of levels, <i>p</i> = 0.002). ASDeg rate was lower in VA (9.8% vs. 27.6%, <i>p</i> = 0.019). Fusion rates were comparable (VA:92.2% vs. PC:97.4%, <i>p</i> = 0.077).</p> Conclusion <p>Zero-P VA spacers offer similar clinical outcomes, but greater loss of IH and cervical curvature and higher subsidence than plate-cage constructs at 3-year follow-up.</p>

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Comparative Evaluation of Zero-Profile Variable-Angle Spacers Versus Plate-Cage Constructs in Bilevel Cervical Spondylotic Myelopathy: A Minimum 3-Year Follow-Up on Radiographic and Clinical Outcomes

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Yu Guo,
  • Qiwen Xie,
  • Dehong Feng,
  • Yi Liu,
  • Ding Li,
  • Junfang Wang

摘要

Background

Plate-cage constructs for contiguous bilevel cervical spondylotic myelopathy (CSM) are effective, but associated with dysphagia and adjacent segment degeneration. Zero-profile variable-angle (Zero-P VA) spacers may reduce these drawbacks, but 3-year radiographic evidence is limited. This study compared 3-year outcomes of Zero-P VA versus plate-cage constructs for contiguous bilevel CSM.

Methods

Patients undergoing bilevel ACDF for CSM with Zero-P VA (VA group, n = 51) or plate-cage constructs (PC group, n = 58) between 2018 and 2021 (≥ 3-year follow-up) were reviewed. Outcomes included JOA/VAS scores, dysphagia (Bazaz system), and radiographic parameters: intervertebral height (IH), cervical Cobb angle (CCA), segmental Cobb angle (SCA), radiographic adjacent segment degeneration (ASDeg), and fusion rates.

Results

Neurological improvement was similar between groups (p > 0.05). VA had shorter operation duration (103.4 vs. 116.1 min, p < 0.05) and less intraoperative bleeding (78.6 vs. 91.2 mL, p < 0.05). Early dysphagia was lower in VA (37.3% vs. 56.9%, p = 0.041). At 3 years, superior IH (PC:7.06 vs. VA:6.55 mm, p = 0.001) and inferior IH (6.97 vs. 6.14 mm, p < 0.001) were better maintained in PC. SCA loss was greater in VA (final SCA: 9.03° vs. 6.58°, p = 0.027). Subsidence rate was higher in VA (10.8% vs. 0.9% of levels, p = 0.002). ASDeg rate was lower in VA (9.8% vs. 27.6%, p = 0.019). Fusion rates were comparable (VA:92.2% vs. PC:97.4%, p = 0.077).

Conclusion

Zero-P VA spacers offer similar clinical outcomes, but greater loss of IH and cervical curvature and higher subsidence than plate-cage constructs at 3-year follow-up.