Use of a bioabsorbable anterior cervical plate in the treatment of cervical degenerative and traumatic disc disruption

Abstract

<jats:p content-type="fine-print"><jats:italic>Object.</jats:italic> Anterior cervical discectomy and fusion (ACDF) is a widely accepted treatment for anterior degenerative or traumatic instability of the cervical spine. To reduce or eliminate complications such as implant migration and failure, imaging degradation, and fusion stress shielding that are occasionally associated with spinal instrumentation, attention has been given to the use of bioresorbable anterior cervical plate (ACP) devices. This paper is a preliminary report of a retrospective series in which a resorbable mesh and screw system was used for graft containment in single-level ACDF.</jats:p> <jats:p content-type="fine-print"><jats:italic>Methods.</jats:italic> A review of patient charts and imaging studies was conducted to determine functional outcome, fusion success, and potential soft-tissue reaction to implant resorption. Nine patients with a cervical degenerative disc disease or traumatic disc disruption were treated between October 2001 and March 2002. Follow up averaged 206 days. Eight patients were found to have an excellent result, one patient had a good result, and no patients had a satisfactory or poor result. At the time of follow-up examination, 77% of patients were found to have a radiographically solid fusion. The two patients without a solid fusion were examined only an average 8 months postoperatively and manifested no symptoms related to fusion nonhealing. No significant soft-tissue reaction was noted clinically or radiographically in any of the patients.</jats:p> <jats:p content-type="fine-print"><jats:italic>Conclusions.</jats:italic> The results of this preliminary study indicate that bioresorbable ACP systems for single-level ACDF are both safe and effective.</jats:p>

Outcomes observed during a 1-year clinical and radiographic follow-up of patients treated for 1- or 2-level cervical degenerative disease using a biodegradable anterior cervical plate

“…Although a multitude of preceding studies have provided encouraging results for the use of bACPs, 2,8,16,18,20,23 other studies echo these concerns. Brkaric et al 4 reported early failure of the Mystique plate in 3 of 6 patients who underwent single-level ACDF.…”

“…6 Several studies of biodegradable plating systems have reported conflicting results in bony fusion rates. [1][2][3][4]8,9,13,15,16,18,20,23,24 Vaccaro et al 23 described the first series of patients treated with a biodegradable anterior cervical mesh in 2002. The fusion rate was 77% (7/9 patients) at an average follow-up of 206 days for single-level ACDF without severe complications or revisions.…”

“…Since the introduction of bACPs, many authors have investigated the feasibility of implantation in vitro and in vivo. [1][2][3][4]8,9,13,15,16,18,20,23,24 Although most of these studies reported promising results, several more recent studies expressed concerns regarding inadequate stability, incompatible properties, and inferior clinical manifestations. 3,4,15,16 The observational findings in the present study provide valuable insight into this critical and controversial clinical issue by clarifying outcomes for bACP use and by comparing these outcomes with those achieved for standard metallic ACP (mACP) implants, to evaluate the potential for bACPs to serve as an alternative to mACPs.…”

The Performance Envelope of Spinal Implants Utilizing Thermoplastic Materials

“…Once adapted for use in spinal applications, RPSS's have been investigated for supplemental anterior fixation to cervical interbody fusion constructs. Although prospective randomized studies to date are limited, many retrospective analyses have concluded resorbable anterior cervical plating as a reasonable alternative to metal (Vaccaro et al 2002;Franco et al 2007;Tomasino et al 2009). RPSSs have also been considered for supplemental lumbar fixation (DiAngelo et al 2002), however in-vivo loading conditions of the lumbar spine may prove too intense for this application.…”

Circumferential Cervical Spine Surgery in an 18-Month-Old Female with Traumatic Disruption of the Odontoid and C3 Vertebrae

“…The patient was stabilized in a halo device for 24 h and surgical intervention was discussed with the family. After informed consent, the patient underwent anterior cervical corpectomy of C3 and the base of C2 with an autologous rib graft and C2-C4 anterior cervical plating with macropore [10]. Posteriorly the patient underwent occipital-C3 fusion with a titanium rod placed in a prepared midline trough and secured to the occiput with wires.…”