• Bin Zhang, Qingquan Kong, Pin Feng, Junlin Liu, and Junsong Ma.
• Department of Orthopedics Surgery, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China.
• World Neurosurg. 2024 Nov 20.

ObjectiveThe purpose of this study was to investigate whether the preservation of the anterior edge of the vertebral body affects the cage subsidence and clinical outcomes after anterior cervical discectomy and fusion(ACDF)using zero-profile cages.MethodsWe retrospectively analyzed 86 patients who underwent 1-3 levels of ACDF using zero-profile cages between December 2017 and June 2023. According to whether the anterior edge was protected, the patients were divided into an intact group and a defect group. Cage subsidence was defined as a ≥2 mm decrease in vertebral height at follow-up compared with measurement on postoperative day 2. The patients' radiological parameters and clinical outcomes were also analyzed.ResultsThe subsidence rate was 17.02% (8/47) in the intact group and 41.03% (16/39) in the defect group(P=0.014). At the last follow-up, all patients in both groups achieved complete intervertebral fusion. The cervical lordosis of the two groups was effectively restored after surgery, and the VAS and NDI scores of the two groups were significantly improved. Multivariate logistic regression analysis showed that the protective factor for zero-profile cage subsidence was bone protection at the anterior edge of the vertebral body (OR=0.270,95%CI=0.091-0.804), and the risk factor was related to the height of the preoperative surgical segment (OR=2.285, 95%CI =1.395-3.743).ConclusionFor patients who undergo ACDF with zero-profile cages, especially those with a higher surgical segment, bone protection at the anterior edge of the vertebral body can effectively reduce the risk of zero-profile cage subsidence, but there is no difference in the final clinical effect.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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