History of instrumentation for stabilization of the subaxial cervical spine

Abstract

<jats:p>In the past several decades methods have been developed to stabilize the subaxial cervical spine both posteriorly and anteriorly. Methods of posterior stabilization have progressed from interspinous wiring, through facet wiring and sublaminar wiring, to the lateral mass screws with plates and rods that are in use today. Plates for anterior stabilization have evolved from rigid plates requiring bicortical screws through those used with unicortical locking screws, to dynamic load-sharing plates used with variable angle screws. The original description of spinous process wiring was published by Hadra in 1891. In 1942 Rogers described the interspinous wiring method used for trauma-induced cervical instability, which was modified by Bohlman in 1985 (triple wiring technique). Luque rods with sublaminar wires were introduced in the late 1970s to address multilevel and occipitocervical instability. Facet wiring was developed in 1977 by Callahan to address the problem of stabilization when laminae are not present. Wiring remained the method used until Roy-Camille introduced the lateral mass screw–plate construct in the 1980s. The first plate for anterior stabilization was designed by Orozco and Llovet in 1970 and was later refined by Caspar; this was a rigid plate with bicortical screws. Morscher devised unicortical locking screws in the 1980s. The latest concept of dynamic load-sharing plates with variable angle screws was developed in 2000. In this article historical landmarks in surgical methods for the stabilization of the subaxial cervical spine are reviewed.</jats:p>

Fusion and failure following anterior cervical plating with dynamic or rigid plates: 6-months results of a multi-centric, prospective, randomized, controlled study

“…Inclusion-as well as exclusion criteria are summarized in Table 1. Between January 1, 2003 and December 31, 2004, 132 patients were recruited, and randomly assigned to receive either a dynamic plate [15] (study group, n = 69), or a constrained, rigid plate [14] (control group, n = 63) in the setting of anterior cervical plating. All patients gave their written informed consent prior to enrolment into the study at least 24 h before surgery.…”

“…This design should allow the screws to glide towards each other in the setting of graft settling. Moreover, the screws are also prevented from loosening by their design [15]. These plates are commonly known as dynamic plates.…”

Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up

“…[46] and Cloward [11], anterior cervical discectomy for cervical spondylosis has been reported with good clinical outcome and fusion rates. In the decades that followed, various modifications of these landmark techniques have been described in the literature, including the addition of ACP by Orozco in 1970 [34]. Fusion rates are high (up to 96%) using either an autograft or allograft with ACP for single-level ACDF [39].…”

Experimental in vivo acute and chronic biomechanical and histomorphometrical comparison of self-drilling and self-tapping anterior cervical screws

“…Multiple factors influence anterior cervical plating strength and stability, including bone mineral density [8,31], bone geometry [27], plate and screw type [31], screw length [5], bone screw interface [10,15,30], and screw orientation [22,28]. Early devices used non-self-tapping screws and required use of a screw that penetrated the posterior cortex of the vertebral body (bicortical purchase) [24,27]. Nonself-tapping screws require a drilled pilot hole followed by the use of a tap to create threads in the bone before screw insertion.…”