Zero-profile devices versus traditional cage-plate systems for geriatric osteoporotic patients with cervical degenerative disc disease: a retrospective analysis of 190 patients.

BACKGROUND

This study compared the clinical and radiological outcomes of zero-profile devices (ZPD) and traditional cage-plate systems (CPS) in anterior cervical discectomy and fusion (ACDF) for geriatric osteoporotic patients with cervical degenerative disc disease (CDDD).

METHODS

Between March 2017 and February 2022, a retrospective cohort study of 190 geriatric osteoporotic patients (81 ZPD, 109 CPS) undergoing single-level ACDF was conducted. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiographic evaluations included cervical alignment (Cobb angle), intervertebral height (IH), total interbody height (TIH), subsidence, fusion rates, and adjacent segment degeneration (ASD). Dysphagia incidence was graded using the Bazaz scale. All patients received standardized anti-osteoporotic treatment.

RESULTS

The ZPD group demonstrated significantly shorter operative times and reduced blood loss (P < 0.05). Both groups exhibited comparable and significant improvements in VAS, NDI, and JOA scores postoperatively. The incidence and severity of early dysphagia (at 48 h and 1 month postoperatively) were significantly lower in the ZPD group (P < 0.05), with multivariate analysis confirming implant type as an independent protective factor against early dysphagia. Radiographic analysis revealed comparable cervical alignment restoration, but the ZPD group showed greater IH loss at 3-year follow-up (P = 0.032). Fusion rates differed significantly at 1-year (61.7% vs 75.2%, P = 0.046) but converged by 3-year follow-up (85.2% vs 90.8%, P = 0.229). The ZPD group showed a trend towards a higher subsidence rate (9.9% vs 2.8%, P = 0.057), which was further confirmed by multivariate analysis identifying ZPD as an independent risk factor (OR 5.479, P = 0.023). ASD incidence was comparable (5 vs 9 cases, P = 0.587). No revisions occurred during follow-up.

CONCLUSION

Both ZPD and CPS were effective for geriatric osteoporotic patients. ZPD offered advantages in surgical efficiency and reduced dysphagia risk. However, ZPD was associated with a higher risk of subsidence and a lower 1-year fusion rate. Anti-osteoporotic treatment played a critical role in optimizing surgical outcomes. Further large-scale, prospective studies are needed to validate long-term outcomes and personalized patient selection.