The optimal revision surgical strategy for patients who develop symptomatic adjacent segment
disc degeneration (ASD) is controversial. The risks of
intraoperative complications, especially the incidence of
dysphagia, were relatively high for
revision surgeries. This study was aimed at comparing the efficacy of
revision surgery using a traditional plate-cage construct and zero-profile anchored spacer (ROI-C) device in treating symptomatic ASD after initial anterior cervical
discectomy and fusion (ACDF) surgery. Forty-two patients who developed symptomatic ASD were retrospectively analyzed and classified into two groups (plate-cage group and ROI-C group). The clinical and radiological results were compared. We further evaluated the complication of
dysphagia and
dysphagia-related risk factors in these patients. The JOA and NDI scores, C2-7 lordotic angle, and intervertebral space height were significantly improved after
revision surgery in both groups. The
operative time and intraoperative blood loss both significantly decreased in the ROI-C group. The incidence of postoperative
dysphagia was much lower in the ROI-C group than in the plate-cage group (18.75% vs. 57.69%; P = 0.01). The presence of
dysphagia after initial surgery (P = 0.003) and
revision surgery type (P = 0.01) was significantly related to the presence of
dysphagia after
revision surgery. These results indicated that both the plate-cage construct and ROI-C are effective in treating symptomatic ASD. However, compared with the traditional plate-cage construct, ROI-C with less
operative time, less blood loss, and lower incidence of
dysphagia is more suitable. Furthermore, ROI-C should preferably be used for patients who present with
dysphagia after initial cervical surgery. This study will provide clinical guidance for spinal surgeons to choose the zero-profile device in treating specific and complicated cases, which will significantly improve the therapeutic efficacy of symptomatic adjacent segment degeneration.