Static versus dynamic plating for multilevel anterior cervical discectomy and fusion

Dubois, Christian; Bolt, Patrick; Todd, Andrew G.; Gupta, Purnendu; Wetzel, F. Todd; Phillips, Frank M.

doi:10.1016/j.spinee.2006.07.004

Cited by 54 publications

(48 citation statements)

References 20 publications

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“…It contributes to ASD causing anterior bony thorns [28,55] as it was observed in the current study. Therefore, DuBoys et al [28] and Ripa et al [82] recommended that plates should be at least 3 mm away of the adjacent disc as micromotions can lead to implant loosening or anterior ossifications that were seen in 77 and 42% of adjacent-cephalad and -caudal levels, respectively, in a study of Park et al [74]. The latter observed that adjacent-level ossifications were more likely to develop and progress if the PDD was \5 mm.…”

Section: Adjacent-segment Degenerationsupporting

confidence: 69%

“…Goffin related ASD to excessive extension of plates up or down into adjacent healthy discs and the extensive surgical dissection and damage to the ALL. Primary or secondary impingement of a plate has been observed [60] but is seldom reported as a technical failure [3,28,60,85]. It contributes to ASD causing anterior bony thorns [28,55] as it was observed in the current study.…”

Section: Adjacent-segment Degenerationsupporting

confidence: 59%

“…Primary or secondary impingement of a plate has been observed [60] but is seldom reported as a technical failure [3,28,60,85]. It contributes to ASD causing anterior bony thorns [28,55] as it was observed in the current study. Therefore, DuBoys et al [28] and Ripa et al [82] recommended that plates should be at least 3 mm away of the adjacent disc as micromotions can lead to implant loosening or anterior ossifications that were seen in 77 and 42% of adjacent-cephalad and -caudal levels, respectively, in a study of Park et al [74].…”

Section: Adjacent-segment Degenerationsupporting

confidence: 59%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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The management of patients with subaxial cervical injuries lacks consensus, particularly in regard to the decision which surgical approach or combination of approaches to use and which approach yields the best clinical outcome in the distinct injury. The trauma literature is replete with reports of surgical techniques, complications and gross outcome assessment in heterogeneous samples. However, data on functional and clinical outcome using validated outcome measures are scanty. Therefore, the authors performed a study on plated anterior cervical decompression and fusion for unstable subaxial injuries with focus on clinical outcome. For the purpose of a strongly homogenous subgroup of patients with subaxial injuries without spinal cord injuries, robust criteria were applied that were fulfilled by 28 patients out of an original series of 131 subaxial injuries. Twenty-six patients subjected to 1-and 2-level fusions without having spinal cord injury could be surveyed after a mean of 5.5 years (range 16-128 months). The cervical spine injury severity score averaged 9.6. Cross-sectional outcome assessment included validated outcome measures (Neck pain disability index, Cervical Spine Outcome Questionnaire, SF-36), the investigation of construct failure and successful surgical outcome were defined by strict criteria, the reconstruction and maintenance of local and total cervical lordosis, adjacent-segment degeneration and intervertebral motion, and the fusion-rate using an interobserver assessment. Selfrated clinical outcome was excellent or good in 81% of patients and moderate or poor in 19% that corresponded to the results of the validated outcome measures. Results of the NPDI averaged 12.4 ± 12.7% (0-40). With the SF-36 mean physical and mental component summary scores were 47.0 ± 9.8 (18.2-59.3) and 52.2 ± 12.4 (14.6-75.3), respectively. Using merely non-constrained plates, construct failure was observed in 31% of cases and loss of local lordosis, expressed as a mean injury angle of 14°, postoperative angle of -5.5°and follow-up angle of -1°, was significant. However, total cervical lordosis was within the limits of normalcy (-24.3°± 13.3) and fusion-rate was 88.5%. The progression of adjacent-level degeneration was shown to be significantly influenced by a decreased plate-to-disc-distance. Adjacent-level intervertebral motion was not altered due to the adjacent fusion, but reduced in Electronic supplementary material The online version of this article

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Section: Adjacent-segment Degenerationsupporting

confidence: 69%

Section: Adjacent-segment Degenerationsupporting

confidence: 59%

Section: Adjacent-segment Degenerationsupporting

confidence: 59%

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Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

et al. 2009

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“…Although primary and secondary migration with impingement of ACPs on adjacent disc spaces is less documented, it can be seen over time in clinical practice and literature [25,27,76,109,114]. We observed it secondarily due to telescoping at the end of a long instrumentation in four of our patients, and primarily in three patients (Fig.…”

Section: Adjacent Disc Degenerationmentioning

confidence: 54%

“…4), as with the hybrid technique or with posterior fixation results in greater resistance to translational and axial loads [28]. Concerning dynamic plate systems, aforescribed concerns and failure rates remain [13,15,19,27,30,31,78,99]. As it was in our series, CSplate systems tend to do better than NC-ones concerning the maintenance of reconstructed lordosis and construct rigidity [67].…”

Section: Biomechanical Considerationsmentioning

confidence: 56%

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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Pitfalls in Cervical Spine Surgery

Denaro¹,

D’Avella²,

Denaro³

2010

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Static versus dynamic plating for multilevel anterior cervical discectomy and fusion

Cited by 54 publications

References 20 publications

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

Mid- to long-term outcome of instrumented anterior cervical fusion for subaxial injuries

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

Pitfalls in Cervical Spine Surgery

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