Comparison of effectiveness of anterior cervical discectomy and fusion with zero-profile three-dimensional-printed interbody fusion Cage and titanium plate fusion Cage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yuwei ¹ , LI Xiuzhi ² , LI Bowen ³ , GU Yunling ¹ , YANG Tiantian ¹ , ZHAO Lei ¹ , CUI Wei ¹ , GU Shifeng ¹ ,  WANG Haijiao ¹

1. Department of Orthopedics, Luohe Central Hospital, Luohe Henan, 462000, P. R. China;
2. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, P. R. China;
3. Clinical College of Henan Northern Medical College, Xinxiang Henan, 453003, P. R. China;

Corresponding author：

WANG Haijiao, Email: 460910316@qq.com

Keywords：

Cervical spondylotic myelopathy; anterior cervical discectomy and fusion; three-dimensional printing; interbody fusion Cage; microporous titanium

DOI：

10.7507/1002-1892.202505049

Video：

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Objective To compare the effectiveness of a zero-profile three-dimensiaonal (3D)-printed microporous titanium Cage and a conventional titanium plate combined with a polyether-ether-ketone (PEEK) -Cage in the treatment of single-level cervical spondylotic myelopathy (CSM) by anterior cervical discectomy and fusion (ACDF). Methods The clinical data of 83 patients with single-segment CSM treated with ACDF between January 2022 and January 2024 were retrospectively analyzed, and they were divided into 3D-ZP group (35 cases, using zero-profile 3D-;rinted microporous titanium alloy Cage) and CP group (48 cases, using titanium plate in combination with PEEK-Cage). There was no significant difference in gender, age, disease duration, surgical intervertebral space, and preoperative Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI), vertebral height at the fusion segment, Cobb angle, and other baseline data between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, complications, interbody fusion, and prosthesis subsidence were recorded and compared between the two groups. VAS score, NDI, and JOA score were used to evaluate the improvement of pain and function before operation, 3 months after operation, and at last follow-up, and the vertebral height and Cobb angle at the fusion segment were measured by imaging. The degree of dysphagia was assessed by the Bazaz dysphagia scale at 1 week and at last follow-up. Results The operation was successfully completed in all the 83 patients. There was no significant difference in intraoperative blood loss and hospital stay between the two groups (P>0.05), but the operation time in the 3D-ZP group was significantly less than that in the CP group (P<0.05). Patients in both groups were followed up 24-35 months, with an average of 25.3 months, and there was no significant difference in the follow-up time between the two groups (P>0.05). The incidence and grade of dysphagia in CP group were significantly higher than those in 3D-ZP group at 1 week after operation and at last follow-up (P<0.05). There was no dysphagia in 3D-ZP group at last follow-up. There was no complication such as implant breakage and displacement in both groups. The intervertebral fusion rates of 3D-ZP group and CP group were 65.71% (23/35) and 60.42% (29/48) respectively at 3 months after operation, and there was no significant difference between the two groups [OR=1.256 (0.507, 3.109), P=0.622]. The JOA score, VAS score, and NDI significantly improved in the 3D-ZP group at 3 months and last follow-up (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the improvement rate of JOA between the two groups at last follow-up (70.39% vs 64.13%) (P>0.05). At 3 months after operation and at last follow-up, the vertebral height and Cobb angle at the fusion level significantly improved in both groups, and the two indexes in 3D-ZP group were significantly better than those in CP group (P<0.05). At last follow-up, the prosthesis subsidence rate in 3D-ZP group (8.57%) was significantly lower than that in CP group (29.16%) (P<0.05). Conclusion The application of zero-profile 3D-printed Cage and titanium plate combined with PEEK-Cage in single-segment ACDF can both reconstruct the stability of cervical spine and achieve good effectiveness. Compared with the latter, the application of the former in ACDF can shorten the operation time, reduce the prosthesis subsidence rate, and reduce the incidence of swallowing discomfort.

1.	Gerdhem L, Vlachogiannis P, Gerdhem P, et al. Cage only or cage with plate fixation in anterior cervical discectomy and fusion surgery-analysis of a national multicenter dataset. Spine J, 2025, 25(5): 947-955.
2.	Abdelmalek G, Uppal H, Coban D, et al. Is cervical disc arthroplasty an effective treatment option for patients with cervical spondylotic myelopathy? A matched cohort analysis compared to anterior cervical discectomy and fusion. Spine J, 2025, 25(5): 921-928.
3.	Chen L, Zhang T, Chen XY, et al. Anterior cervical discectomy and fusion in treating acute myelopathy caused by Brucella cervical spondylitis: a case series. Ann Med, 2025, 57(1): 2493308. doi: 10.1080/07853890.2025.2493308.
4.	Zhao ER, Kamil R, Kaidi AC, et al. Zero-profile stand-alone cages versus traditional cage-and-plate constructs in single and multi-level anterior cervical discectomy and fusion: A propensity-matched analysis using validated fusion assessment methods. Global Spine J, 2025. doi: 10.1177/21925682251329228.
5.	Arun-Kumar V, Corluka S, Buser Z, et al. Do osteobiologics augment fusion in anterior cervical discectomy and fusion surgery performed with mechanical interbody devices (polyether ether ketone, carbon fiber, metal cages) and is the fusion rate comparable to that with autograft? A systematic review. Global Spine J, 2024, 14(2_suppl): 24S-33S.
6.	Zhai WJ, Liu L, Gao YH, et al. Application of 3D-printed porous titanium interbody fusion cage vs. polyether ether ketone interbody fusion cage in anterior cervical discectomy and fusion: A systematic review and meta-analysis update. Exp Ther Med, 2024, 28(1): 290. doi: 10.3892/etm.2024.12579.
7.	Mayer F, Heider F, Haasters F, et al. Radiological and clinical outcomes after anterior cervical discectomy and fusion (ACDF) with an innovative 3D printed cellular titanium cage filled with vertebral bone marrow. Biomed Res Int, 2022, 2022: 6339910. doi: 10.1155/2022/6339910.
8.	Aljohani H, Alashkar AH, Abdulazim M, et al. Early dysphagia following anterior cervical discectomy and fusion: a centre experience. BMC Res Notes, 2025, 18(1): 162. doi: 10.1186/s13104-025-07215-1.
9.	Hayashi T, Murata S, Iwahashi H, et al. Efficacy of titanium-coated PEEK cages with two blades in anterior cervical decompression fixation: Bone fusion rates and surgical outcomes. J Orthop Sci, 2025 Apr 10: S0949-2658.
10.	Chang CJ, Liu YF, Hsiao YM, et al. Comparison of stand-alone anchored spacer and plate-cage construct for surgical treatment of multilevel cervical degenerative spondylopathy: A meta-analysis. Global Spine J, 2025. doi: 10.1177/21925682251327599.
11.	李玉伟, 李修智, 谷世锋, 等. 自稳定零切迹3D打印人工椎体在颈椎后纵韧带骨化症治疗中的应用观察. 中华医学杂志, 2024, 104(7): 526-532.
12.	Ni S, Yang R, Liu S, et al. Biomechanical analysis of a newly designed and 3D printed plate-locking interbody cage: an observational study of finite element analysis. Sci Rep, 2025, 15(1): 3534. doi: 10.1038/s41598-025-88151-9.
13.	Dou X, Liu X, Liu Y, et al. Biomimetic porous Ti6Al4V implants: A novel interbody fusion cage via gel-casting technique to promote spine fusion. Adv Healthc Mater, 2024, 13(27): e2400550. doi: 10.1002/adhm.202400550.
14.	黄靖, 熊云宇, 周子然, 等. 颈椎前路椎间盘切除融合术中可变角度零切迹椎间融合器与钛板椎间融合器固定的疗效比较. 中华骨科杂志, 2025, 45(4): 205-214.
15.	Tang Y, Geng X, Li F, et al. Factors affecting titanium mesh cage subsidence in single-level anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. J Orthop Surg Res, 2022, 17(1): 515. doi: 10.1186/s13018-022-03409-6.
16.	Zhao C, Wang S, Zhang J, et al. Facet distraction distance independently predicts cage subsidence following anterior cervical discectomy and fusion. World Neurosurg, 2025. doi: 10.1016/j.wneu.2025.123960.
17.	Louie PK, Kumar R, Bansal A, et al. Are variable screw angle change and screw-to-vertebral body ratio associated with radiographic subsidence following anterior cervical discectomy and fusion? Global Spine J, 2025, 15(3): 1582-1591.
18.	Sever C, Kilinc BE, Akpolat AO, et al. A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation. J Orthop Surg Res, 2025, 20(1): 256. doi: 10.1186/s13018-025-05654-x.
19.	He H, Fan L, Lü G, et al. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord, 2024, 25(1): 96. doi: 10.1186/s12891-024-07213-7.
20.	李玉伟, 王海蛟, 崔巍, 等. 3D打印微孔钛合金人工椎体治疗颈椎后纵韧带骨化症的临床疗效观察. 陆军军医大学学报, 2022, 44(15): 1542-1548.
21.	Zhu J, Cui Y, Shen H, et al. Biomechanical performance of a novel zero-profile interbody cage: A cadaveric study. PLoS One, 2025, 20(4): e0317375. doi: 10.1371/journal.pone.0317375.
22.	Durand WM, Khanna R, Nazario-Ferrer GI, et al. Revision surgery after single level anterior cervical discectomy and fusion with plate vs stand-alone cage over 2 to 5 year follow-up. Global Spine J, 2025, 15(4): 2014-2019.
23.	Wang F, Lu J, Wang B, et al. Is screw position a greater contributor to adjacent segment disease than plate-to-disc distance following anterior cervical discectomy and fusion? BMC Musculoskelet Disord, 2025, 26(1): 297. doi: 10.1186/s12891-025-08285-9.
24.	Lee SH, Raad M, Cohen DB, et al. Risk factors for “adjacent-level ossification development” other than short plate-to-disc distance and clinical implications for adjacent-segment pathology. Neurospine, 2025, 22(1): 194-201.
25.	Luan H, Liu X, Liu K, et al. Development and validation of a predictive model to evaluate the risk of dysphagia following anterior cervical discectomy and fusion. Global Spine J, 2025, 15(2): 679-688.
26.	Kiran S, Khan ZM, Anwar K, et al. A comparative analysis of the clinical and radiological results of a zero-profile device versus conventional cage and plate following single-level anterior cervical discectomy and fusion. Cureus, 2025, 17(3): e80067. doi: 10.7759/cureus.80067.

1. Gerdhem L, Vlachogiannis P, Gerdhem P, et al. Cage only or cage with plate fixation in anterior cervical discectomy and fusion surgery-analysis of a national multicenter dataset. Spine J, 2025, 25(5): 947-955.
2. Abdelmalek G, Uppal H, Coban D, et al. Is cervical disc arthroplasty an effective treatment option for patients with cervical spondylotic myelopathy? A matched cohort analysis compared to anterior cervical discectomy and fusion. Spine J, 2025, 25(5): 921-928.
3. Chen L, Zhang T, Chen XY, et al. Anterior cervical discectomy and fusion in treating acute myelopathy caused by Brucella cervical spondylitis: a case series. Ann Med, 2025, 57(1): 2493308. doi: 10.1080/07853890.2025.2493308.
4. Zhao ER, Kamil R, Kaidi AC, et al. Zero-profile stand-alone cages versus traditional cage-and-plate constructs in single and multi-level anterior cervical discectomy and fusion: A propensity-matched analysis using validated fusion assessment methods. Global Spine J, 2025. doi: 10.1177/21925682251329228.
5. Arun-Kumar V, Corluka S, Buser Z, et al. Do osteobiologics augment fusion in anterior cervical discectomy and fusion surgery performed with mechanical interbody devices (polyether ether ketone, carbon fiber, metal cages) and is the fusion rate comparable to that with autograft? A systematic review. Global Spine J, 2024, 14(2_suppl): 24S-33S.
6. Zhai WJ, Liu L, Gao YH, et al. Application of 3D-printed porous titanium interbody fusion cage vs. polyether ether ketone interbody fusion cage in anterior cervical discectomy and fusion: A systematic review and meta-analysis update. Exp Ther Med, 2024, 28(1): 290. doi: 10.3892/etm.2024.12579.
7. Mayer F, Heider F, Haasters F, et al. Radiological and clinical outcomes after anterior cervical discectomy and fusion (ACDF) with an innovative 3D printed cellular titanium cage filled with vertebral bone marrow. Biomed Res Int, 2022, 2022: 6339910. doi: 10.1155/2022/6339910.
8. Aljohani H, Alashkar AH, Abdulazim M, et al. Early dysphagia following anterior cervical discectomy and fusion: a centre experience. BMC Res Notes, 2025, 18(1): 162. doi: 10.1186/s13104-025-07215-1.
9. Hayashi T, Murata S, Iwahashi H, et al. Efficacy of titanium-coated PEEK cages with two blades in anterior cervical decompression fixation: Bone fusion rates and surgical outcomes. J Orthop Sci, 2025 Apr 10: S0949-2658.
10. Chang CJ, Liu YF, Hsiao YM, et al. Comparison of stand-alone anchored spacer and plate-cage construct for surgical treatment of multilevel cervical degenerative spondylopathy: A meta-analysis. Global Spine J, 2025. doi: 10.1177/21925682251327599.
11. 李玉伟, 李修智, 谷世锋, 等. 自稳定零切迹3D打印人工椎体在颈椎后纵韧带骨化症治疗中的应用观察. 中华医学杂志, 2024, 104(7): 526-532.
12. Ni S, Yang R, Liu S, et al. Biomechanical analysis of a newly designed and 3D printed plate-locking interbody cage: an observational study of finite element analysis. Sci Rep, 2025, 15(1): 3534. doi: 10.1038/s41598-025-88151-9.
13. Dou X, Liu X, Liu Y, et al. Biomimetic porous Ti6Al4V implants: A novel interbody fusion cage via gel-casting technique to promote spine fusion. Adv Healthc Mater, 2024, 13(27): e2400550. doi: 10.1002/adhm.202400550.
14. 黄靖, 熊云宇, 周子然, 等. 颈椎前路椎间盘切除融合术中可变角度零切迹椎间融合器与钛板椎间融合器固定的疗效比较. 中华骨科杂志, 2025, 45(4): 205-214.
15. Tang Y, Geng X, Li F, et al. Factors affecting titanium mesh cage subsidence in single-level anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament. J Orthop Surg Res, 2022, 17(1): 515. doi: 10.1186/s13018-022-03409-6.
16. Zhao C, Wang S, Zhang J, et al. Facet distraction distance independently predicts cage subsidence following anterior cervical discectomy and fusion. World Neurosurg, 2025. doi: 10.1016/j.wneu.2025.123960.
17. Louie PK, Kumar R, Bansal A, et al. Are variable screw angle change and screw-to-vertebral body ratio associated with radiographic subsidence following anterior cervical discectomy and fusion? Global Spine J, 2025, 15(3): 1582-1591.
18. Sever C, Kilinc BE, Akpolat AO, et al. A retrospective comparative analysis of anterior cervical discectomy and fusion using stand-alone titanium cage versus cage and plate fixation in two-level cervical disc herniation. J Orthop Surg Res, 2025, 20(1): 256. doi: 10.1186/s13018-025-05654-x.
19. He H, Fan L, Lü G, et al. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord, 2024, 25(1): 96. doi: 10.1186/s12891-024-07213-7.
20. 李玉伟, 王海蛟, 崔巍, 等. 3D打印微孔钛合金人工椎体治疗颈椎后纵韧带骨化症的临床疗效观察. 陆军军医大学学报, 2022, 44(15): 1542-1548.
21. Zhu J, Cui Y, Shen H, et al. Biomechanical performance of a novel zero-profile interbody cage: A cadaveric study. PLoS One, 2025, 20(4): e0317375. doi: 10.1371/journal.pone.0317375.
22. Durand WM, Khanna R, Nazario-Ferrer GI, et al. Revision surgery after single level anterior cervical discectomy and fusion with plate vs stand-alone cage over 2 to 5 year follow-up. Global Spine J, 2025, 15(4): 2014-2019.
23. Wang F, Lu J, Wang B, et al. Is screw position a greater contributor to adjacent segment disease than plate-to-disc distance following anterior cervical discectomy and fusion? BMC Musculoskelet Disord, 2025, 26(1): 297. doi: 10.1186/s12891-025-08285-9.
24. Lee SH, Raad M, Cohen DB, et al. Risk factors for “adjacent-level ossification development” other than short plate-to-disc distance and clinical implications for adjacent-segment pathology. Neurospine, 2025, 22(1): 194-201.
25. Luan H, Liu X, Liu K, et al. Development and validation of a predictive model to evaluate the risk of dysphagia following anterior cervical discectomy and fusion. Global Spine J, 2025, 15(2): 679-688.
26. Kiran S, Khan ZM, Anwar K, et al. A comparative analysis of the clinical and radiological results of a zero-profile device versus conventional cage and plate following single-level anterior cervical discectomy and fusion. Cureus, 2025, 17(3): e80067. doi: 10.7759/cureus.80067.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesComparison of effectiveness of anterior cervical discectomy and fusion with zero-profile three-dimensional-printed interbody fusion Cage and titanium plate fusion Cage

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