A systematic review and meta-analysis of Anterior Cervical Decompression and Fusion: Comparing the ROI-CTM Self-Locking System with Traditional Cage-Plate Internal Fixation in the Treatment of Degenerative Cervical Spondylosis

Objective: Anterior Cervical Decompression and Fusion (ACDF) is a well-established surgical intervention for degenerative cervical spondylosis. While the use of plates is known to improve fusion rates and stability, it may also be associated with an increased risk of adjacent vertebral degeneration and postoperative dysphagia. This meta-analysis aims to compare the clinical outcomes and complications between the ROI-C ^TM self-locking system and traditional cage-plate internal fixation in the context of ACDF for degenerative cervical spondylosis to guide the selection of appropriate internal fixation methods. Methods: A comprehensive literature search was conducted in PubMed, Cochrane Library, Web of Science, and Embase to identify relevant English-language studies on the use of the ROI-C ^TM self-locking system and cage-plate internal fixation in ACDF for degenerative cervical spondylosis and the search period spanned from the inception of each database to September 2024. Two researchers independently screened and selected studies based on predefined inclusion and exclusion criteria. The quality of the included randomized controlled trials was strictly assessed according to the Cochrane Collaboration's guidelines, and the Newcastle-Ottawa Scale (NOS) was applied to evaluate the quality of cohort studies. The meta-analysis was performed using RevMan 5.4 software, with outcome indicators including operation time, intraoperative blood loss, Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI), C2-C7 Cobb angle, fusion rate, incidence of adjacent segment degeneration, cage subsidence rate, and incidence of dysphagia. Results: The analysis included ten articles, consisting of nine retrospective cohort studies and one randomized controlled trial, encompassing 947 patients (468 in the ROI-C group and 479 in the fusion cage-plate group). The meta-analysis revealed that the ROI-C group had significantly shorter operation times [MD = -14.03, 95% CI (-17.12, -10.95), P < 0.00001] and less intraoperative blood loss [MD = -16.34, 95% CI (-19.84, -12.84), P < 0.00001] compared to the cage-plate group. Furthermore, the ROI-C group exhibited a significantly lower rate of postoperative adjacent segment degeneration [RR = 0.40, 95% CI (0.27, 0.60), P < 0.00001] and total dysphagia rate [RR = 0.20, 95% CI (0.14, 0.29), P < 0.00001]. However, no significant differences were observed between the two groups in terms of JOA score, NDI index, C2-C7 Cobb angle, fusion rate, and cage subsidence rate (P≥0.05). Conclusion: In the context of ACDF procedures, both the ROI-C ^TM self-locking system and traditional cage-plate internal fixation provide satisfactory clinical results. The ROI-C ^TM self-locking system streamlines the ACDF process, significantly reducing operation times and intraoperative blood loss. It also presents a clear advantage in lowering the risk of postoperative dysphagia and adjacent segment degeneration. However, due to the potential for higher cage subsidence rates, its use should be approached with caution in patients with risk factors for cage subsidence, such as osteoporosis and vertebral endplate damage.