REVIEW
Introdução: A artrodese cervical via anterior (ACDF) é amplamente utilizada para tratar patologias da coluna cervical. No entanto, o uso de placas cervicais anteriores tem sido associado a complicações pós-operatórias, particularmente disfagia. Objetivo: avaliar se a placa anterior aumenta o risco de disfagia quando comparada com sistemas sem placa. Métodos: Foram realizadas uma revisão sistemática e uma meta-análise utilizando o PubMed (2014–2024) com os termos “ anterior cervical discectomy and fusion”, “stand-alone” e “placing”. Foram extraídos dados de estudos elegíveis sobre demografia dos doentes, níveis cirúrgicos, tempo operatório, perda de sangue e taxas de disfagia. O risco de viés foi avaliado com a ferramenta Cochrane Collaboration. Resultados: Foram incluídos cinquenta e sete estudos com 4603 doentes. Destas, 1396 foram submetidas a chapas e 3207 foram submetidas a ACDF sem placa. A demografia e os níveis cirúrgicos foram semelhantes entre os grupos. Os doentes com placas tiveram tempos operatórios significativamente mais longos, maior perda de sangue e uma maior incidência de disfagia tanto no seguimento inicial como no final. Discussão: A presença de blindagem anterior correlaciona-se com um aumento do trauma cirúrgico, podendo contribuir para as taxas mais elevadas de disfagia observadas. Estratégias minimamente invasivas e dispositivos autónomos podem mitigar este risco. Conclusão: O uso de placas cervicais anteriores está significativamente associado a um maior risco de disfagia pós-operatória. Evitar o revestimento em casos selecionados pode reduzir a morbilidade e melhorar os resultados dos pacientes.
Introduction: Anterior cervical discectomy and fusion (ACDF) is widely used to treat cervical spine pathologies. However, the use of anterior cervical plating has been associated with postoperative complications, particularly dysphagia. Objective: to assess whether anterior plating increases the risk of dysphagia when compared to no-plate systems. Methods: A systematic review and meta-analysis were performed using PubMed (2014–2024) with the terms “anterior cervical discectomy and fusion,” “stand-alone,” and “plating.” Data were extracted from eligible studies on patient demographics, surgical levels, operative time, blood loss, and dysphagia rates. Risk of bias was assessed with the Cochrane Collaboration tool. Results: Fifty-seven studies comprising 4603 patients were included. Of these, 1396 underwent plating and 3207 underwent no-plate ACDF. Demographics and surgical levels were similar between groups. Plated patients had significantly longer operative times, greater blood loss, and a higher incidence of dysphagia at both initial and final follow-up. Discussion: The presence of anterior plating correlates with increased surgical trauma, potentially contributing to the higher dysphagia rates observed. Minimally invasive strategies and stand-alone devices may mitigate this risk. Conclusion: The use of anterior cervical plates is significantly associated with a higher risk of postoperative dysphagia. Avoiding plating in selected cases may reduce morbidity and improve patient outcomes.
1.Hosp. 1955;96:223-4. Robinson RA, Smith GW. Anterolateral disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins
On the other hand, the use of the anterior plate reveals the biomechanical advantages of this strategy. The presence of the plate increases the stability of the operated segment and reduces the movement between the graft placed in the intervertebral space and the surface of the vertebrae, increasing the chances of arthrodesis of the operated segment. In this way, the plate not only acts as a barrier to prevent the graft displacing, but also as a support that prevents the graft from collapsing and subsidence into the vertebral endplate. In addition, the plate helps maintain sagittal balance and prevents post-operative kyphosis75.
is sufficient, as they are mechanically efficient and has lower complication rates and a lower incidence of post-operative dysphagia.
LIMITATIONS
There was only one randomized clinical trial in our review, and our analysis included mainly prospective and retrospective cohort studies. There was a significant difference in postoperative follow-up between the studies, regarding the mean time and frequency of follow-up. Some studies did not specify the number of levels operated or which levels were approached, making it difficult to determine if more high or low levels were operated. Our review was limited by the search in only one database, and only studies published in English were considered.
2. Iunes EA, Barletta EA, Belsuzarri TAB, et al. Pseudarthrosis in anterior cervical discectomy and fusion with a self-locking, stand-alone cage filled with hydroxyapatite: a retrospective study with clinical and radiological outcomes of 98 levels with a minimum 2-year follow-up. J Neurosurg Spine. 2020;33(6):717-26. https://doi.org/10.3171/2020.4.SPINE20357. PMid:32736356.
3. Fountas KN, Kapsalaki EZ, Nikolakakos LG, et al. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32(21):2310-7. https://doi.org/10.1097/BRS.0b013e318154c57e. PMid:17906571.
4. He S, Feng H, Lan Z, et al. Randomized trial comparing clinical outcomes between zero-profile and traditional multilevel anterior cervical discectomy and fusion surgery for cervical myelopathy. Spine. 2018;43(5):E259-66. https://doi.org/10.1097/BRS.0000000000002323. PMid:29432408.
5. Lancaster J. Dysphagia: its nature, assessment and management. Br J Community Nurs. 2015;5(Sup6a):S28-32. https://doi.org/10.12968/ bjcn.2015.20.Sup6a.S28. PMid:26087205.
6. McCarty EB, Chao TN. Dysphagia and swallowing disorders. Med Clin North Am. 2021;105(5):939-54. https:// doi.org/10.1016/j.mcna.2021.05.013. PMid:34391544.
7. Khan A, Carmona R, Traube M. Dysphagia in the elderly. Clin Geriatr Med. 2014;30(1):43-53. https://doi.org/10.1016/j.cger.2013.10.009. PMid:24267601.
8. Epstein NE. A review of complication rates for Anterior Cervical Diskectomy and Fusion (ACDF). Surg Neurol Int. 2019;10:100. https:// doi.org/10.25259/SNI-191-2019. PMid:31528438.
9. Wilkinson JM, Codipilly DC, Wilfahrt RP. Dysphagia: evaluation and collaborative management. Am Fam Physician. 2021;103(2):97106. PMid:33448766.
10. Rommel N, Hamdy S. Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol. 2016;13(1):49-59. https:// doi.org/10.1038/nrgastro.2015.199. PMid:26627547.
11. Alhashash M, Allouch H, Boehm H, Shousha M. Results of four-level anterior cervical discectomy and fusion using stand-alone interbody titanium cages. Asian Spine J. 2022;16(1):82-91. https://doi.org/10.31616/ asj.2020.0463. PMid:33687861.
12. Poblete J, Martinez-Anda JJ, Rebollar-Mendoza AA, et al. Clinical and radiological outcome in a series of patients treated by anterior cervical discectomy and fusion: retrospective controlled study with 2 different stand-alone cages. Int J Spine Surg. 2022;16(5):779-91. https:// doi.org/10.14444/8351. PMid:35985833.
13. Mu G, Chen H, Fu H, et al. Anterior cervical discectomy and fusion with zero-profile versus stand-alone cages for two-level cervical spondylosis: a retrospective cohort study. Front Surg. 2022;9:1002744. https://doi.org/10.3389/fsurg.2022.1002744. PMid:36406351.
14. Theologou M, Theologou T, Skoulios N, et al. Long-term outcome following three-level stand-alone anterior cervical discectomy and fusion: is plating necessary? Asian J Neurosurg. 2020;15(3):554-9. https://doi.org/10.4103/ajns.AJNS_196_19. PMid:33145206.
15. Xiong Y, Xu L, Bi LY, et al. Dynamic fusion process in the anterior cervical discectomy and fusion with self-locking stand-alone cages. World Neurosurg. 2019;125:e678-87. https:// doi.org/10.1016/j.wneu.2019.01.152. PMid:30735878.
16. Kapetanakis S, Thomaidis T, Charitoudis G, Pavlidis P, Theodosiadis P, Gkasdaris G. Single anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg. 2017;3(3):312-22. https://doi.org/10.21037/jss.2017.06.21. PMid:29057338.
17. Yeung KKL, Cheung PWH, Cheung JPY. Anterior cervical discectomy and fusion for cervical myelopathy using stand-alone tricortical iliac crest autograft: predictive factors for neurological and fusion outcomes. J Orthop Surg (Hong Kong). 2019;27(3):2309499019869166. https:// doi.org/10.1177/2309499019869166. PMid:31451033.
18. Lee SH, Lee JS, Sung SK, Son DW, Lee SW, Song GSA. Lower T1 slope as a predictor of subsidence in anterior cervical discectomy and fusion with stand-alone cages. J Korean Neurosurg Soc. 2017;60(5):567-76. https://doi.org/10.3340/jkns.2017.0404.001. PMid:28881120.
19. Overley SC, Merrill RK, Leven DM, Meaike JJ, Kumar A, Qureshi SA. A matched cohort analysis comparing stand-alone cages and anterior cervical plates used for anterior cervical discectomy and fusion. Global Spine J. 2017;7(5):394-9. https://doi.org/10.1177/2192568217699211. PMid:28811982.
20. Tang L, Liu X, Lu Y, Liu Y, Yu J, Zhao J. Clinical and imaging outcomes of self-locking stand-alone cages and anterior cage-with-plate in threelevel anterior cervical discectomy and fusion: a retrospective comparative study. J Orthop Surg Res. 2023;18(1):276. https://doi.org/10.1186/ s13018-023-03726-4. PMid:37020306.
21. Chen Y, Lü G, Wang B, Li L, Kuang L. A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking standalone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J. 2016;25(7):2255-62. https://doi.org/10.1007/s00586-0164391-x. PMid:26906171.
22. Yamagata T, Naito K, Yoshimura M, Ohata K, Takami T. Influence of prevertebral soft tissue swelling on dysphagia after anterior cervical discectomy and fusion using a rectangular titanium stand-alone cage. J Craniovertebr Junction Spine. 2017;8(3):179-86. https://doi.org/10.4103/ jcvjs.JCVJS_57_17. PMid:29021668.
23. Shin JS, Oh SH, Cho PG. Surgical outcome of a zero-profile device comparing with stand-alone cage and anterior cervical plate with iliac bone graft in the anterior cervical discectomy and fusion. Korean J Spine. 2014;11(3):169-77. https://doi.org/10.14245/kjs.2014.11.3.169. PMid:25346764.
24. Mostafa H, Lotfy M, Wahid M. Long-term results of multiple anterior cervical discectomy with cage fusion technique: results of multiple centre study. Open Access Maced J Med Sci. 2019;7(17):2824-8. https:// doi.org/10.3889/oamjms.2019.631. PMid:31844444.
25. Njoku I Jr, Alimi M, Leng LZ, et al. Anterior cervical discectomy and fusion with a zero-profile integrated plate and spacer device: a clinical and radiological study: clinical article. J Neurosurg Spine. 2014;21(4): 529-37. https://doi.org/10.3171/2014.6.SPINE12951. PMid:25105338.
26. Shi S, Liu ZD, You WJ, et al. Application of a stand-alone anchored spacer in noncontiguous anterior cervical arthrodesis with radiologic analysis of the intermediate segment. J Clin Neurosci. 2016;25:69-74. https://doi.org/10.1016/j.jocn.2015.05.050. PMid:26597607.
27. Liang Y, Xu S, Yu G, Zhu Z, Liu H. Cervical spine alignment and clinical outcomes after multilevel anterior cervical decompression and fusion with or without plate: A minimal 5-year follow-up of a CONSORTcompliant article. Medicine (Baltimore). 2021;100(30):e26126. https://doi.org/10.1097/MD.0000000000026126. PMid:34397682.
28. Zhu D, Zhang D, Liu B, Li C, Zhu J. Can Self-Locking Cages Offer the Same Clinical Outcomes as Anterior Cage-with-Plate Fixation for 3-Level Anterior Cervical Discectomy and Fusion (ACDF) in Mid-Term
Follow-Up? Med Sci Monit. 2019;25:547-57. https://doi.org/10.12659/ MSM.911234. PMid:30659165.
29. Zhou J, Li J, Lin H, Li X, Zhou X, Dong J. 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;170:73-8. https://doi.org/10.1016/j.clineuro.2018.04.033. PMid:29734112.
30. Nambiar M, Phan K, Cunningham JE, Yang Y, Turner PL, Mobbs R. Locking stand-alone cages versus anterior plate constructs in singlelevel fusion for degenerative cervical disease: a systematic review and meta-analysis. Eur Spine J. 2017;26(9):2258-66. https://doi.org/10.1007/ s00586-017-5015-9. PMid:28283840.
31. El-Tantawy A. Is it possible to eliminate the plate-related problems and still achieve satisfactory outcome after multilevel anterior cervical discectomy? Eur J Orthop Surg Traumatol. 2015;25(Suppl 1):S135-45.
https://doi.org/10.1007/s00590-015-1611-8. PMid:25708620.
32. Gerszten PC, Paschel E, Mashaly H, Sabry H, Jalalod’din H, Saoud K. Outcomes Evaluation of Zero-Profile Devices Compared to Stand-Alone PEEK Cages for the Treatment of Three- and Four-Level Cervical Disc Disease. Cureus. 2016;8(9):e775. https://doi.org/10.7759/cureus.775. PMid:27738574.
33. Shi S, Zheng S, Li XF, Yang LL, Liu ZD, Yuan W. Comparison of a Stand-Alone Anchored Spacer Versus Plate-Cage Construct in the Treatment of Two Noncontiguous Levels of Cervical Spondylosis: A Preliminary Investigation. World Neurosurg. 2016;89:285-92. https:// doi.org/10.1016/j.wneu.2016.02.009. PMid:26868426.
34. Zhang B, Jiang YZ, Song QP, An Y. Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage. World J Clin Cases. 2022;10(15):4776-84. https://doi.org/10.12998/wjcc.v10.i15.4776. PMid:35801046.
35. Zhang J, Wang S, Tang X, et al. Clinical and radiological comparison of the zero-profile anchored cage and traditional cage-plate fixation in single-level anterior cervical discectomy and fusion. Eur J Med Res. 2022;27(1):189. https://doi.org/10.1186/s40001-022-00813-w. PMid:36175990.
36. He S, Zhou Z, Shao X, et al. Comparing the Bridge-Type Zero-Profile Anchored Spacer (ROI-C) Interbody fusion cage system and anterior cervical discectomy and fusion (ACDF) with plating and cage system in cervical spondylotic myelopathy. Orthop Surg. 2022;14(6):1100-8. https://doi.org/10.1111/os.13268. PMid:35478487.
37. Guo J, Jin W, Shi Y, et al. Is the Zero-P Spacer Suitable for 3-Level Anterior Cervical Discectomy and Fusion Surgery in Terms of Sagittal Alignment Reconstruction: A Comparison Study with Traditional Plate and Cage System. Brain Sci. 2022;12(11):1583. https://doi.org/10.3390/ brainsci12111583. PMid:36421907.
38. Xue R, Ji ZY, Cheng XD, Zhang ZQ, Zhang F. Risk Factors for Dysphagia after Anterior Cervical Discectomy and Fusion with the Zero-P implant system: A Study with Minimum of 2 Years Follow-up. Orthop Surg. 2022;14(1):149-56. https://doi.org/10.1111/os.13170. PMid:34841666.
39. Sommaruga S, Camara-Quintana J, Patel K, et al. 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. J Clin Med. 2021;10(14):3076. https:// doi.org/10.3390/jcm10143076. PMid:34300241.
40. He S, Zhou Z, Lv N, et al. Comparison of clinical outcomes following anterior cervical discectomy and fusion with zero-profile anchored spacer-ROI-C-Fixation and Combined Intervertebral Cage and Anterior Cervical Discectomy and Fusion: A Retrospective Study from a Single Center. Med Sci Monit. 2021;27:e931050. https://doi.org/10.12659/ MSM.931050. PMid:34392301.
41. Wang Z, Jiang W, Li X, et al. The application of zero-profile anchored spacer in anterior cervical discectomy and fusion. Eur Spine J. 2015;24(1):148-54. https://doi.org/10.1007/s00586-014-3628-9. PMid:25337859.
42. Bucci MN, Oh D, Cowan RS, et al. The ROI-C zero-profile anchored spacer for anterior cervical discectomy and fusion: biomechanical profile and clinical outcomes. Med Devices (Auckl). 2017;10:61-9. https://doi.org/10.2147/MDER.S127133. PMid:28458586.
43. Tabaraee E, Ahn J, Bohl DD, et al. Comparison of surgical outcomes, narcotics utilization, and costs after an anterior cervical discectomy and fusion: stand-alone cage versus anterior plating. Clin Spine Surg. 2017;30(9): E1201-5. https://doi.org/10.1097/BSD.0000000000000341. PMid:29049131.
44. Wang YP, Zhang W, An JL, Lian LC, Zhang J, Sun YP. A comparative study for the usage of Fidji cervical cages after multilevel anterior cervical discectomy and fusion. Injury. 2019;50(4):908-12. https:// doi.org/10.1016/j.injury.2019.03.029. PMid:30952496.
45. Kim SJ, Kim SD. Anterior cervical discectomy and fusion using a double cylindrical cage versus an anterior cervical plating system with iliac crest autografts for the treatment of cervical degenerative disc disease. J Korean Neurosurg Soc. 2014;55(1):12-7. https://doi.org/10.3340/ jkns.2014.55.1.12. PMid:24570812.
46. Wang 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):462-6. https://doi.org/10.1016/j.jocn.2013.05.019. PMid:24262773.
47. Zhang 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. https://doi.org/10.1186/s12891-018-2033-7. PMid:29665815.
48. Liu Y, Wang H, Li X, et al. Comparison of a zero-profile anchored spacer (ROI-C) and the polyetheretherketone (PEEK) cages with an anterior plate in anterior cervical discectomy and fusion for multilevel cervical spondylotic myelopathy. Eur Spine J. 2016;25(6):1881-90. https://doi.org/10.1007/s00586-016-4500-x. PMid:26968876.
49. He S, Feng H, Lan Z, et al. A Randomized trial comparing clinical outcomes between zero-profile and traditional multilevel anterior cervical discectomy and fusion surgery for cervical myelopathy. Spine. 2018;43(5):E259-66. https://doi.org/10.1097/BRS.0000000000002323. PMid:29432408.
50. Zhang L, Wang J, Tao Y, Feng X, Yang J, Zhang S. 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):416-22. PMid:27161470.
51. Chen Y, Chen H, Cao P, Yuan W. Anterior cervical interbody fusion with the Zero-P spacer: mid-term results of two-level fusion. Eur Spine J. 2015;24(8):1666-72. https://doi.org/10.1007/s00586-015-3919-9. PMid:25850390.
52. Thind H, Aura AB, Lee P, et al. 2-level anterior cervical arthrodesis with integrated spacer and plate vs traditional anterior spacer and plate system. Int J Spine Surg. 2022;16(2):215-21. https:// doi.org/10.14444/8206. PMid:35273112.
53. Son DK, Son DW, Kim HS, Sung SK, Lee SW, Song GS. Comparative study of clinical and radiological outcomes of a zero-profile device concerning reduced postoperative Dysphagia after single level anterior cervical discectomy and fusion. J Korean Neurosurg Soc. 2014;56(2):103-7. https://doi.org/10.3340/jkns.2014.56.2.103. PMid:25328646.
54. Maragkos GA, Motiei-Langroudi R, Arle J. Safety and Efficacy of the VariLift-C® cervical standalone interbody fusion device with emphasis on multiple-level and prior fusion cases. Cureus. 2019;11(10):e5885. https://doi.org/10.7759/cureus.5885. PMid:31772855.
55. Li 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):1129-39. https://doi.org/10.1007/s00586-016-4739-2. PMid:27554353.
56. Lonjon N, Favreul E, Huppert J, Lioret E, Delhaye M, Mraidi R. Clinical and radiological outcomes of a cervical cage with integrated fixation. Medicine (Baltimore). 2019;98(3):e14097. https:// doi.org/10.1097/MD.0000000000014097. PMid:30653129.
57. El Baz EA, Sultan AM, Barakat AS, Koptan W, ElMiligui Y, Shaker H. The use of anterior cervical interbody spacer with integrated fixation screws for management of cervical disc disease. SICOT J. 2019;5:8. https://doi.org/10.1051/sicotj/2019002. PMid:30834889.
58. Arts M, Torensma B, Wolfs J. Porous titanium cervical interbody fusion device in the treatment of degenerative cervical radiculopathy; 1-year results of a prospective controlled trial. Spine J. 2020;20(7):1065-72. https://doi.org/10.1016/j.spinee.2020.03.008. PMid:32205276.
59. Fisahn C, Schmidt C, Rustagi T, et al. Comparison of chronic dysphagia in standalone versus conventional plate and cage fusion. World Neurosurg. 2018;109:e382-8. https://doi.org/10.1016/j.wneu.2017.09.188. PMid:28987856.
60. Wang Z, Zhu X, Wang Z, et al. Zero-P and ROI-C implants versus traditional titanium plate with cage to treat cervical spondylotic myelopathy: clinical and radiological results with 5 years of follow-up. BMC Musculoskelet Disord. 2023;24(1):539. https://doi.org/10.1186/ s12891-023-06657-7. PMid:37391741.
61. Wang C, Zhang Y, Yuan W. Early Clinical outcomes and radiographic features after treatment of cervical degenerative disk disease with the new zero-profile implant: a 1-year follow-up retrospective study. Clin Spine Surg. 2016;29(2):E73-9. https://doi.org/10.1097/ BSD.0000000000000101. PMid:26889995.
62. Hofstetter CP, Kesavabhotla K, Boockvar JA. Zero-profile anchored spacer reduces rate of dysphagia compared with ACDF with anterior plating. J Spinal Disord Tech. 2015;28(5):E284-90. https:// doi.org/10.1097/BSD.0b013e31828873ed. PMid:23429316.
63. Sun B, Shi C, Wu H, et al. Application of zero-profile spacer in the treatment of three-level cervical spondylotic myelopathy: 5-year follow-up results. Spine. 2020;45(8):504-11. https://doi.org/10.1097/ BRS.0000000000003312. PMid:32224806.
64. Shi S, Liu ZD, Li XF, Qian L, Zhong GB, Chen FJ. Comparison of plate-cage construct and stand-alone anchored spacer in the surgical treatment of three-level cervical spondylotic myelopathy: a preliminary clinical study. Spine J. 2015;15(9):1973-80. https:// doi.org/10.1016/j.spinee.2015.04.024. PMid:25912505.
65. Wang Z, Zhu R, Yang H, et al. Zero-profile implant (Zero-p) versus plate cage benezech implant (PCB) in the treatment of single-level cervical spondylotic myelopathy. BMC Musculoskelet Disord. 2015;16(1):290. https://doi.org/10.1186/s12891-015-0746-4. PMid:26459625.
66. Lan T, Lin JZ, Hu SY, Yang XJ, Chen Y. Comparison between zero-profile spacer and plate with cage in the treatment of single level cervical spondylosis. J Back Musculoskelet Rehabil. 2018;31(2): 299-304. https://doi.org/10.3233/BMR-169708. PMid:29171978.
67. Lu Y, Bao W, Wang Z, et al. Comparison of the clinical effects of zeroprofile anchored spacer (ROI-C) and conventional cage-plate construct for the treatment of noncontiguous bilevel of cervical degenerative disc disease (CDDD): a minimum 2-year follow-up. Medicine (Baltimore). 2018;97(5):e9808. https://doi.org/10.1097/MD.0000000000009808. PMid:29384883.
68. Cho SK, Lu Y, Lee DH. Dysphagia following anterior cervical spinal surgery: a systematic review. Bone Joint J. 2013;95-B(7):868-73. https:// doi.org/10.1302/0301-620X.95B7.31029. PMid:23814234.
69. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery. Spine. 2002;27(22):2453-8. https://doi.org/10.1097/00007632200211150-00007. PMid:12435974.
70. Martin RE, Neary MA, Diamant NE. Dysphagia following Anterior Cervical Spine Surgery. Dysphagia. 1997;12(1):2-8, discussion 9-10. https://doi.org/10.1007/PL00009513. PMid:8997826.
71. Wang Z, Jiang W, Li X, et al. The application of zero-profile anchored spacer in anterior cervical discectomy and fusion. Eur Spine J. 2015;24(1):148-54. https://doi.org/10.1007/s00586-014-3628-9.
72. Lee MJ, Bazaz R, Furey CG, Yoo J. Influence of Anterior Cervical Plate Design on Dysphagia. J Spinal Disord Tech. 2005;18(5):406-9. https://doi.org/10.1097/01.bsd.0000177211.44960.71. PMid:16189451.
73. Zhang D, Liu B, Zhu J, et al. Comparison of Clinical and Radiologic Outcomes Between Self-Locking Stand-Alone Cage and Cage with Anterior Plate for Multilevel Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg. 2019;125:e117-31. https:// doi.org/10.1016/j.wneu.2018.12.218. PMid:30677575.
74. Duan Y, Yang Y, Wang Y, et al. Comparison of anterior cervical discectomy and fusion with the zero-profile device versus plate and cage in treating cervical degenerative disc disease: a meta-analysis. J Clin Neurosci. 2016;33:11-8. https://doi.org/10.1016/j.jocn.2016.01.046. PMid:27443497.
75. Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J. 2005;5(2):140-4. https:// doi.org/10.1016/j.spinee.2004.06.022. PMid:15749613.
1Santa Casa de Limeira, Limeira, SP, Brazil.
2Universidade Nove de Julho, São Paulo, SP, Brazil.
Received Aug 1, 2025
Accepted Aug 15, 2025
