Anterior Cervical Plate Used in Degenerative Disease Can Maintain Cervical Lordosis

Katsuura, Akitomo; Hukuda, Sinsuke; Imanaka, Toru; Miyamoto, Kouji; Kanemoto, Masakuni

doi:10.1097/00002517-199612000-00003

Cited by 129 publications

(54 citation statements)

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“…17 The results presented in this paper demonstrate the radiographic and clinical efficacy of the Atlantis ACP system at minimum 1-year follow up in 77 patients. We have found the flexibility of the Atlantis ACP system advantageous in tailoring anterior cervical constructs to individual patient biomechanical needs.…”

Section: Neurosurg Focus / Volume 12 / January 2002mentioning

confidence: 51%

“…Examples of unrestricted backout systems include the Caspar and Morscher plate systems. [6][7][8][9]14,15,17,18,23 Hardware failure in ACP systems, defined as any broken or loosened screw or plate, ranges from 2 to 44% in unrestricted backout systems. 6,19,22 Generally, lower hardware failure rates, ranging from 0 to 18%, have been reported for restricted backout systems with unicortical locking screws, which provide greater screw pullout protection.…”

Section: Discussionmentioning

confidence: 99%

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Early results using the Atlantis anterior cervical plate system

Barnes¹,

Haid²,

Rodts³

et al. 2002

FOC

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Object The authors present a retrospective review of 77 patients in whom they performed anterior cervical discectomy and fusion (ACDF) in the treatment of radiculopathy and/or myelopathy. In all cases anterior interbody fusion was performed using the Atlantis locking plate system to treat the degenerative disease. Methods There were 41 men and 36 women (mean age 53.8 years), and 24 active cigarette smokers (31%) in the group. All patients presented with signs and symptoms of cervical radiculopathy and/or myelopathy, and magnetic resonance imaging or computerized tomography myelography demonstrated evidence of radicular and/or spinal cord compression at one or more cervical levels. Thirty-one patients underwent single-level ACDF, 20 patients underwent multilevel ACDF without posterior instrumentation, in eight patients one- to four-level corpectomies were supplemented with posterior fixation, 12 patients underwent single-level corpectomy, and six patients underwent multilevel corpectomy with no posterior instrumentation. The mean follow-up period was 15.33 months; overall good-to-excellent outcome was seen in 75% of patients; osseous fusion was demonstrated in 93.5%. In all patients except three, fibular allograft was used as graft material. The degree of overall cervical lordosis was measured at the last follow up and was compared with normal values obtained in age-matched individuals. In addition, the degree of cervical lordosis at fusion levels was compared with overall cervical lordosis. In patients in all five of the aforementioned categories significantly less lordosis was demonstrated than in age-matched controls. In patients who underwent single-level ACDF, single-level corpectomy, and multilevel ACDF significantly less lordosis was observed at the fusion segment than that in the overall cervical spine. Complications included one episode of chronic anterior wound drainage treated with intravenous antibiotic medication and one postoperative posterior wound infection, which required reoperation and intravenous antibiotic medication. Two cases (2.6%) of anterior screw backout and/or breakage were identified. One patient died of unrelated causes within 3 months of operation. Conclusions These initial results indicate that use of the Atlantis plate system for anterior cervical arthrodesis produces fusion rates and clinical outcomes that are comparable with those obtained using other locking plating systems. It has the unique advantage, however, of providing the surgeon with the choice of fixed, variable, or hybrid screw constructs as a way of tailoring screw angles to individual anatomical/biomechanical needs.

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Section: Neurosurg Focus / Volume 12 / January 2002mentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Early results using the Atlantis anterior cervical plate system

Barnes¹,

Haid²,

Rodts³

et al. 2002

FOC

View full text Add to dashboard Cite

show abstract

“…TMCs are sufficiently rigid and are designed to resist compression and torque [35]. The addition of an ACP resists bending forces and theoretically protects against dislodgement of the cage, helps in maintaining cervical lordosis [24,53], and is reported to have higher fusion rates [58,62].…”

Section: Groupmentioning

confidence: 99%

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

et al. 2009

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Retrospective comparative study of 80 consecutive patients treated with either anterior cervical discectomy fusion (ACDF) or anterior cervical corpectomy fusion (ACCF) for multi-level cervical spondylosis. To compare clinical outcome, fusion rates, and complications of anterior cervical reconstruction of multi-level ACDF and single-/multi-level ACCF performed using titanium mesh cages (TMCs) filled with autograft and anterior cervical plates (ACPs). Reconstruction of the cervical spine after discectomy or corpectomy with titanium cages filled with autograft has become an acceptable alternative to both allograft and autograft; however, there is no data comparing the outcome of multi-level ACDF and single-/multi-level ACCF using this reconstruction. We evaluated 80 consecutive patients who underwent surgery for the treatment of multi-level cervical spondylosis at our institution from 1998 to 2001. In this series, 42 patients underwent multi-level ACDF (Group 1) and 38 patients underwent ACCF (Group 2). Interbody TMCs and local autograft bone with ACPs were used in both procedures. Medical records were reviewed to assess outcome. Clinical outcome was measured by Odom's criteria. Operative time and blood loss were noted. Radiographs were obtained at 6 and 12 weeks, 6 months, 1 year, and 2 years (if necessary). Early hardware failures and pseudarthroses were noted. Cervical sagittal curvature was measured by Ishihara's index at 1 year. Group 1 had a mean age 46.2 years (range 35-60 years). Group 2 had a mean age 50.1 years (range 35-70 years).The operative time was significantly lower (P \ 0.001) and blood loss significantly higher (P \ 0.001) in Group 2 than in Group 1. At a minimum of 1 year follow up, patients in both groups had equivalent improvement in their clinical symptoms. The fusion rates for Group 1 were 97.6 and 92.1% for Group 2. The rates of early hardware failure were higher in Group 2 (2.6%) than in Group 1 (0%). The fusion rates for Group 1 were not significantly higher than Group 2 (P [ 0.28). There was one patient in Group 1 and 2 patients in Group 2 with pseudarthroses. Complication rates in Group 2 were not significantly higher (P [ 0.341). Cervical lordosis was well-maintained (80%) in both groups. Both multi-level ACDF and ACCF with anterior cervical reconstruction using TMC filled with autograft and ACP for treatment of multi-level cervical spondylosis have high fusion rates and good clinical outcome. However, there is a higher rate of early hardware failure and pseudarthroses after ACCF than ACDF. Hence, in the absence of specific pathology requiring removal of vertebral body, multi-level ACDF using interbody cages and autologous bone graft could result in lower morbidity.

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“…In the past, the rate of complications with non-instrumented multilevel anterior cervical fusions has raised concerns [96], and necessitated prolonged immobilization with the Halo device. Thus it was desirable, and infact, using instrumentations gained an increase in lordotic curvature, as well as an increased primary stability with higher fusion rates [12,22,37,49,57,76,96,98]. However, it was scrutinized that with the advantage of anterior cervical spine instrumentations came their own shortcomings, such as implant related complications [12,20,37,115,117].…”

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confidence: 99%

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

et al. 2007

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In the future, there will be an increased number of cervical revision surgeries, including 4-and more-levels. But, there is a paucity of literature concerning the geometrical and clinical outcome in these challenging reconstructions. To contribute to current knowledge, we want to share our experience with 4-and 5-level anterior cervical fusions in 26 cases in sight of a critical review of literature. At index procedure, almost 50% of our patients had previous cervical surgeries performed. Besides failed prior surgeries, indications included degenerative multilevel instability and spondylotic myelopathy with cervical kyphosis. An average of 4.1 levels was instrumented and fused using constrained (26.9%) and non-constrained (73.1%) screw-plate systems. At all, four patients had 3-level corpectomies, and three had additional posterior stabilization and fusion. Mean age of patients at index procedure was 54 years with a mean follow-up intervall of 30.9 months. Preoperative lordosis C2-7 was 6.5°in average, which measured a mean of 15.6°at last follow-up. Postoperative lordosis at fusion block was 14.4°in average, and 13.6°at last follow-up. In 34.6% of patients some kind of postoperative change in construct geometry was observed, but without any catastrophic construct failure. There were two delayed unions, but finally union rate was 100% without any need for the Halo device. Eleven patients (42.3%) showed an excellent outcome, twelve good (46.2%), one fair (3.8%), and two poor (7.7%). The study demonstrated that anterior-only instrumentations following segmental decompressions or use of the hybrid technique with discontinuous corpectomies can avoid the need for posterior supplemental surgery in 4-and 5-level surgeries. However, also the review of literature shows that decreased construct rigidity following more than 2-level corpectomies can demand 360°instrumentation and fusion. Concerning construct rigidity and radiolographic course, constrained plates did better than non-constrained ones. The discussion of our results are accompanied by a detailed review of literature, shedding light on the biomechanical challenges in multilevel cervical procedures and suggests conclusions.

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Anterior Cervical Plate Used in Degenerative Disease Can Maintain Cervical Lordosis

Cited by 129 publications

References 0 publications

Early results using the Atlantis anterior cervical plate system

Early results using the Atlantis anterior cervical plate system

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results

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