Short Plate with Screw Angle over 20 Degrees Improves the Radiologic Outcome in ACDF: Clinical Study

Abstract

Background: Anterior cervical discectomy and fusion surgery is a common procedure for degenerative cervical spine. This describes allospacer and implant-related outcomes, comparing medium plate–low screw angle and short plate–high screw angle techniques. Methods: From January 2016 to June 2019, 79 patients who underwent ACDF were prospectively enrolled. Patients were divided, depending on the plate–screw system used: medium plate–low screw angle (12.3 ± 2.5 to 13.2 ± 3.2 degrees), and short plate–high screw angle (22.8 ± 5.3 to 23.3 ± 4.7 degrees). Subsidence, ALOD, and sagittal cervical balance were analyzed using lateral cervical X-rays. NDI and VAS scores were also evaluated. Results: Age for medium plate–low-angled screw group is 58.0 ± 11.3 years, and 55.3 ± 12.0 in the short plate–high-angled screw group (p-value = 0.313). Groups were comparable in mean NDI (p-value = 0.347), VAS (p-value = 0.156), C2–C7 SVA, (p-value = 0.981), and lordosis angle (p-value = 0.836) at 1-year post-surgery. Subsidence was higher in the medium plate–low-angled screw than in the short plate–high-angled screw (25% and 8.5%, respectively, p-value = 0.045). ALOD is also more common in the medium plate group (p-value = 0.045). Conclusion: Use of a short plate and insertion of high-angled screws (more than 20 degrees) has less chance of subsidence and occurrence of ALOD than the traditional technique of using medium plate and low angle.

Assessment of Biomechanical Advantages in Combined Anterior–Posterior Cervical Spine Surgery by Radiological Outcomes: Pedicle Screws over Lateral Mass Screws

“…The C2-C7 cervical lordosis (CL) and C2-C7 sagittal vertical axis (SVA) were used for cervical sagittal balance [30]. Improvement in cervical sagittal balance has been proven to be important in prevention of adjacent segment disease requiring revision surgery and has been shown to have better clinical outcomes [31][32][33]. The C2-7 CL was measured with Cobb's method: the angle formed by the perpendicular lines parallel to the inferior endplates of C2 and C7 [34].…”

Clinical Efficacy Analysis of the New PRUNUS Spine Plate System for Anterior Cervical Spine Surgery

“…Hence, the revision of the surgeries has been increased. 4 , 5 For elderly patients with cervical spondylosis complicated by osteoporosis, the cervical vertebral body is obviously osteoporotic, and improper selection of internal fixation will often lead to higher risks of plate displacement, screw loosening, and non‐fusion of bone grafts, increasing the risk of anterior surgery renovation rate. To solve the technical issues associated with plate displacement and screw loosening, our team has provided a new type of PRUNUS screw‐plate system that is used for the anterior cervical vertebral surgery.…”

“…Although the application of the screw‐plate system for anterior cervical fixation showed good clinical results, 2,3 other postoperative complications may occur, including spinal injury, plate displacement, screw loosening and plate or screw fracture. Hence, the revision of the surgeries has been increased 4,5 . For elderly patients with cervical spondylosis complicated by osteoporosis, the cervical vertebral body is obviously osteoporotic, and improper selection of internal fixation will often lead to higher risks of plate displacement, screw loosening, and non‐fusion of bone grafts, increasing the risk of anterior surgery renovation rate.…”