ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2021
Clinical impact of 3-level anterior cervical decompression and fusion (ACDF) on the occipito-atlantoaxial complex: a retrospective study of patients who received a zero-profile anchored spacer versus cage-plate construct.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Long-term effectiveness of stand-alone anchored spacer in multilevel anterior cervical discectomy and fusion compared with cage-plate system: a systematic review and meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Pooled it
- A bone graft substitute is effective for posterior spinal fusion in patients with juvenile or adolescent idiopathic scoliosis: a retrospective study.Journal of spine surgery (Hong Kong) · 2026Article
- Comparison between plate cage system and stand-alone cage in the treatment of cervical spondylotic myelopathy patients with cervical kyphosis: clinical and radiographic outcomes.Frontiers in surgery · 2026Article
- Zero-profile devices versus traditional cage-plate systems for geriatric osteoporotic patients with cervical degenerative disc disease: a retrospective analysis of 190 patients.European journal of medical research · 2025Article
- The Impact of Multilevel Anterior Cervical Discectomy and Fusion on Cervical Sagittal Alignment: A Comparative Study of Single-, Two-, and Three-Level Procedures.Journal of clinical medicine · 2025Article
- Article
- Zero-profile implant system versus novel plate systems after ACDF for comparison of sagittal balance parameters and clinical efficacy analysis.Journal of orthopaedic surgery and research · 2024Article
- Comparative analysis of risk factors associated with degeneration of adjacent segments: zero-profile anchored spacer vs. anterior cervical plate and cage construct.Frontiers in medicine · 2024Article
- Outcomes of different zero-profile spacers in the treatment of two-level cervical degenerative disk disease.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2023Article
- Is 3D-printed Titanium cage a reliable option for 3-level anterior cervical discectomy and fusion in treating degenerative cervical spondylosis?Frontiers in surgery · 2023Article
- Article
- Anatomical and Imaging Study on the Optimum Entry Point and Trajectory for Anterior Transpedicular Root Screw Placement into the Lower Cervical Spine.Computational and mathematical methods in medicine · 2022Article
- The clinical validity of atlantoaxial joint inclination angle and reduction index for atlantoaxial dislocation.Frontiers in surgery · 2022Article
- Four-level anterior cervical discectomy and fusion versus posterior cervical fusion: Perioperative outcomes, complications, and sagittal alignment in multilevel cervical pathology.Journal of craniovertebral junction & spineArticle
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate changes in the sagittal parameters of the occipito-atlantoaxial complex after three-level anterior cervical decompression and fusion (ACDF) and identify the influential factors by comparing ACDF with a zero-profile anchored spacer (ACDF-Z) versus a cage-plate construct (ACDF-P).
methodsThe cohort comprised 106 patients who underwent three-level contiguous ACDF-Z or ACDF-P for cervical radiculopathy and/or myelopathy. Standing, flexion, and extension radiographs of cervical spine were obtained preoperatively, and 3 and 12 months postoperatively. The assessed cervical sagittal parameters were the platform angle of the axis, Cobb angle, and range of motion (ROM) of C2⁃7, C0⁃1, and C1⁃2.
resultsIn both the ACDF-Z and ACDF-P groups, the Cobb angle of the upper cervical spine decreased and the C0-1 ROM increased from preoperatively to 3 and 12 months postoperatively (P < 0.01). The alignment restoration was lost at 12 months compared with 3 months in the ACDF-Z group, but not in the ACDF-P group (P < 0.01). The ACDF-P group showed more loss of C2-7 ROM and more compensatory changes in C0-2 ROM than the ACDF-Z group (P < 0.05).
conclusionThe Cobb angle decreased and ROM increased significantly as compensatory changes of the atlantooccipital or atlantoaxial joint after both types of ACDF, which may accelerate degeneration. The zero-profile anchored spacer had less impact on the occipito-atlantoaxial complex but was worse at maintaining the alignment restoration, which were contrary to the cage-plate construct. Surgeons should be aware of the impact of multi-level ACDFs on the occipito-atlantoaxial complex.
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