Anterior Cervical Plating Enhances Arthrodesis after Discectomy and Fusion with Cortical Allograft

Kaiser, Michael G.; Haid, Regis W.; Subach, Brian R.; Barnes, Brian R.; Rodts, Gerald E.

doi:10.1227/00006123-200202000-00001

Cited by 114 publications

(173 citation statements)

References 49 publications

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“…4,5,8,16,20,26,29 The mean fusion rate for singlelevel corpectomies in our series (91.6%) compares favorably with a recent report of 87% in single-level corpectomy in which the Atlantis system was used (Fig. 6).…”

Section: Neurosurg Focus / Volume 12 / January 2002supporting

confidence: 86%

“…22,27,28,31 Controversy still exists with regard to the added value of using a cervical plate for one-level discectomy and fusion procedures, but ACPs have been shown to increase fusion rates in single-level corpectomies and multilevel cervical procedures. 8,10,16,[32][33][34] Most systems currently available are ones in which screws are drilled into vertebrae at predetermined angles only or at variable angles only, without consideration of individual needs such as aberrant anatomy or suboptimum screw purchase.…”

mentioning

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 2002supporting

confidence: 86%

mentioning

confidence: 99%

Early results using the Atlantis anterior cervical plate system

Barnes¹,

Haid²,

Rodts³

et al. 2002

FOC

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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Purpose To analyze the prospectively collected data in a series of patients treated with single-or multilevel ACDF with a stand-alone, zero-profile device, focusing on clinicoradiological outcome, complications and technical hints, and to review the literature on such new devices. Methods Eighty-five patients harboring symptomatic DDD underwent ACDF with the Zero-P cage-plate: 29 at 1-level and 56 at 2-4 levels (total 162 devices). In the multilevel group, 9 patients received a combination of Zero-P and stand-alone cages (hybrid implants). This study focuses on 32 patients with follow-up ranging from 20 to 48 months. NDI, SF-36 and arm pain VAS scores were registered preoperatively and at follow-up visits. Dysphagia was assessed using the Bazaz score. Imaging included X-rays, CT and MRI, also to assess the presence of vertebral body fractures in multilevel cases. Paired Student t test was used for statistical analysis. Results SF-36 and NDI showed a statistically significant improvement (p \ 0.01) and mean arm pain VAS score decreased from 79 to 41. X-rays and CT demonstrated, respectively, a 94.5 % and a 92 % fusion rate. Three patients complained of moderate and two of mild transient dysphagia (15.5 %). No device-related complications occurred and no fractures, secondary to four screws insertion in one vertebral body (i.e., swiss cheese effect), were detected in multilevel cases. In patients with extensive anterior osteophytes only a ''focal spondylectomy'' was required. Conclusion The Zero-P device is safe and efficient, even in multilevel cases. Dysphagia is minimal, extensive anterior osteophytectomy is unnecessary and technical hints may ease the surgical workflow. This is the largest series, with the longest follow-up, reported.

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“…nterior cervical plates are effective in achieving immediate stability, restoring the normal lordotic curve, and increasing fusion rates [1][2][3][4] . However, the development of late adjacent-level degenerative changes, such as anterior osteophyte formation or ossification of the anterior longitudinal ligament, has been reported following anterior cervical arthrodesis [5][6][7][8][9][10][11] .…”

Section: Discussionmentioning

confidence: 99%