Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems

Lehmann, Wolfgang; Briem, D.; Blauth, M.; Schmidt, Ulf

doi:10.1007/s00586-004-0746-9

Cited by 25 publications

(17 citation statements)

References 32 publications

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“…However, in terms of biomechanical rigidity use of uni-versus bi-cortical screws remains an issue of debate [69,87]. Previous studies demonstrated a slightly enhanced stability with bi-cortical purchase [1,35,64,93,108]. But, following multilevel decompressions neither uni-nor bicortical screw fixation will determine the success of the construct survival, rather using a primary stable grafting technique, intermediate fixations points, whenever possible, and early scheduling posterior surgery if indicated.…”

Section: Biomechanical Considerationsmentioning

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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Section: Biomechanical Considerationsmentioning

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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“…It should also be pointed out that the H plate modality used in the study (Orozco plate) is an unlocked platefixation system and monocortical fixation of the plate screws was used. In an experimental study, Lehman et al [5] observed that neither locked nor unlocked anterior-plate fixation can increase stability in all models of testing. H-plate spondylodesis with unlocked screws seems to provide sufficient mechanical integrity in most cases of monosegmental lesions.…”

Section: Resultsmentioning

confidence: 99%

Anterior C2–C3 fixation with screws: proposal of a new technique and comparative mechanical assays

2005

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“…Zahlreiche Arbeiten haben sich mit den mechanischen Eigenschaften der verschiedenen Stabilisationssysteme und den damit erreichten klinischen Ergebnissen beschäftigt [7,14,19,20,21,36,40,41,42,56,61]. Trotz kontroverser Aussagen scheint sicher zu sein, dass die klinischen Ergebnisse durch die kombinierte Verwendung eines Plattensystems mit einem den Diskusraum straff füllen-den Platzhalter (Cage, "strut graft", Kompositgraft) wesentlich verbessert wurden [3,4,10,11,13,16,18,28,29,37,38,39,50,52,60].…”

Section: Diskussionunclassified

“…Ein winkelinstabiles oder dynamisches Plattensystem [7,14,19,20,21,40,41,42] lässt im Interface zwischen Schraubenkopf und Platte drei Arten von Bewegungen zu: F Rotation ("pivoting"), F Wanken ("toggling"), F Verschiebung ("translocation").…”

Section: Winkelinstabile Plattensystemeunclassified

“…Die Qualität und Quantität der Stabilität wird durch die mechanischen Eigenschaften des verwendeten Osteosynthesematerials und durch die Qualität des eigenen Knochens entschieden [7,14,19,20,21,36,40,41,42,56,61]. Die Vaskularität wird von der körpereigenen örtlichen Gewebequalität und besonders von der Art des eingesetzten Transplantatsmaterials/ Ersatzmaterials beeinflusst [8,47,58].…”

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Vordere Spondylodesen an der unteren Halswirbelsäule

Sándor

Barzó

Kuncz

et al. 2008

Chirurg

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Physical alterations in cervical fusions endanger healing. Experimentally we determined less stability loss in fixations using cancellous bone grafts than in those using tricortical grafts. Four hundred eighty-five Patients underwent anterior cervical fusion, for a total of 700 Segments. Patients were divided into four groups: (1) nonlocked H plate with autogenous cancellous bone, (2) nonlocked H plate with autogenous tricortical graft, (3) locked cervical plate with tricortical graft, and (4) stand-alone cage with cancellous bone. Evaluations included X-ray and random CT scan examinations. Our results suggest that anterior cervical fusions using nonlocked H screw plate systems with pure autogenous cancellous bone grafts provide the fastest (6 weeks) and most secure bone healing (P=0.00001), whereas fixations using nonlocked or locked screw plate systems and tricortical autograft require prolonged healing and develop nonunions more frequently. Complete consolidation was achieved using stand-alone cages filled with pure autogenous cancellous bone, but bony healing was delayed due to the cage. Rate of nonunions were: groups 1 and 4 0%, and groups 2 and 3 4.5% and 21%, respectively.

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Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems

Cited by 25 publications

References 32 publications

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

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

Anterior C2–C3 fixation with screws: proposal of a new technique and comparative mechanical assays

Vordere Spondylodesen an der unteren Halswirbelsäule

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