Comparative efficacy of zero-profile implant and conventional cage-plate implant in the treatment of single-level degenerative cervical spondylosis: a systematic review and meta-analysis

Background In recent years, the zero-profile implant (Zero-p) has emerged as a promising internal fixation technique. Although studies have indicated its potential superiority over conventional cage-plate implant (Cage-plate) in the treatment of degenerative cervical spondylosis, there remains a lack of definitive comparative reports regarding its indications, safety, and efficacy. Methods A computerized search was conducted on English and Chinese databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, Wanfang and VIP. Additionally, a manual search was meticulously carried out on Chinese medical journals, spanning from the inception of the respective databases until August 2023. The meta-analysis utilized a case-control study approach and was executed through the utilization of RevMan 5.3 software. Stringent quality evaluation and data extraction procedures were implemented to guarantee the reliability and validity of the findings. Results Nine high-quality studies with 808 patients were included. Meta-analysis showed that the operation time (MD = - 13.28; 95% CI (- 17.53, - 9.04), P < 0.00001), intraoperative blood loss (MD = - 6.61; 95% CI (- 10.47, - 2.75), P = 0.0008), incidence of postoperative dysphagia at various time points: within the first month after surgery (OR = 0.36; 95% CI (0.22, 0.58), P < 0.0001), 1-3 months after surgery (OR = 0.20; 95% CI (0.08, 0.49), P = 0.0004), the final follow-up (OR = 0.21; 95% CI (0.05, 0.83), P = 0.003) and the rate of postoperative adjacent disc degeneration (OR = 0.46; 95% CI (0.25, 0.84), P = 0.01) were significantly lower in the Zero-p group than in the Cage-plate group. Additionally, was also significantly lower in the Zero-p group. However, there were no significant differences in the JOA score, the final follow-up NDI score, surgical segmental fusion rate, postoperative height of adjacent vertebrae, or postoperative subsidence rate between the two groups. Conclusion In summary, when treating single-segment degenerative cervical spondylosis, both internal fixation techniques are reliable and effective. However, Zero-P implant offer several advantages over cage-plate implant, including shorter operation duration, less intraoperative blood loss, reduced postoperative dysphagia, and slower adjacent disc degeneration. Additionally, Zero-P implant has a broader application space, making them a preferred choice in certain cases.