Implant Complications, Fusion, Loss of Lordosis, and Outcome After Anterior Cervical Plating With Dynamic or Rigid Plates

Abstract

Dynamic cervical plate designs provide less implant complications (no patient) compared with rigid plate designs (4 patients). Speed of fusion was faster in the presence of a dynamic plate. However, loss of segmental lordosis is significantly higher if dynamic plates are used, which did not result in differences regarding clinical outcome between dynamic and constrained plates after 2 years. Thus, dynamic plates should be considered to be the preferred treatment option because of the lower risk for implant failure-related revision surgery.

Zero-P: a new zero-profile cage-plate device for single and multilevel ACDF. A single Institution series with four years maximum follow-up and review of the literature on zero-profile devices

“…The former include a higher fusion rate, particularly in multilevel cases, a better alignment of the cervical spine, with restoration or maintenance of lordosis, and the prevention of interbody graft/cage dislocation or subsidence [28]. Among the latter, dysphagia and tracheoesophageal lesions are the most frequently reported [9,31].…”

“…Pitzen et al [28] analyzed the differences in fusion rates, complications and changes in segmental lordosis in patients treated with dynamic plates versus rigid ones. They found that when a dynamic plate is used the fusion process is faster and the implant-related complications are lower.…”

“…Radiographic interbody fusion was accepted if no radiolucencies could be detected in the graft-endplate area and bridging trabeculation was seen [28,34].…”

“…Anterior cervical plates may increase interbody fusion rates [6,10,16,35] and stability [16], maintain or improve cervical sagittal alignment [18,28] and prevent interbody graft dislocation or subsidence [28], particularly in multiple-level ACDFs; however, anterior plating may also be associated with potential disadvantages and complications [17], including increased dysphagia rates [5,29,37,41], tracheoesophageal lesions [31], plate malposition and accelerated adjacent disc degeneration [31], even when low-profile plates are used. Furthermore, in patients harboring spondylotic alterations, such as anterior endplates osteophytes or extensive anterior bony ossification bridging several vertebral bodies, a careful surgical preparation of the anterior surface of the cervical spine, i.e., adequate ''flattening'' of the bony anterior cervical surface, is required to position the plate.…”

Outcome evaluation of zero-profile implant compared with an anterior plate and cage used in anterior cervical discectomy and fusion: a two-year follow-up study

“…Surgeons also prefer to add an anterior plate to enhance rigidity of fixation especially in multi-level cases (11,23,24). Although the design of the current anterior plate has been improved over the years, the complications related to the plates are still not rare, and include screw loosening or breakage, plate breakage, and screw pullout with or without migration into the gastrointestinal tract (15,25).…”