Evid Based Spine Care J 2010; 1(1): 41-46
DOI: 10.1055/s-0028-1100892
Original research
© Georg Thieme Verlag KG Stuttgart · New York

Dynamic anterior cervical plating for multi-level spondylosis: Does it help?

Ashraf A. Ragab, F. Spain Hodges, Clint P. Hill, Robert A. McGuire, Michelle Tucci
  • 1University of Mississippi Medical Center, Jackson, MS, USA
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Publikationsverlauf

Publikationsdatum:
06. Juli 2010 (online)

Abstract

Study design: Randomized controlled trial.

Objective: To compare fusion rates, time to fusion, complication rates and subsidence between 1) a static, 2) a dynamic angulation, and 3) a dynamic translation plate in anterior cervical discectomy and fusion for symptomatic degenerative cervical disease.

Methods: Thirty-six patients with two level, symptomatic cervical degenerative changes requiring surgery were randomized in a blinded fashion to receive a statically locked plate, Cervical Spine Locking Plate (CSLP) (Synthes, Paoli, PN, USA), an Atlantis Vision® Anterior Cervical Plate System (Medtronic, Memphis, TN, USA) which allows angular dynamization, or a Premier® Anterior Cervical Plate System (Medtronic) which allows translational dynamization. Structured data collection and measurement protocols were used. Intervertebral composite allograft cages were used in all groups. Identical external immobilization and antiinflammatory medication protocols were followed. X-rays were obtained at preset time points postoperatively. Assessment of the primary outcomes was blinded. Rate of and time to fusion, graft / instrumentation complications, subsidence, and reoperation for adjacent level disease were measured. Paired t-test and three-way Analysis of Variance test (ANOVA) were used to assess statistical differences between groups.

Results: The three groups were similar demographically. Fusion rates in the CSLP, Atlantis and Premier plate groups were 100%, 91%, and 92% respectively. Mean time to fusion was 6.1, 8.3 and 6.3 months respectively but differences were not statistically significant. Mean subsidence in the groups was 1.9, 1.6, and 2.6 mm respectively. Subsidence was found even for the static (CSLP) plate, but no statistically significant differences were found.

Conclusions:We found no clinical advantage of dynamic plates over static plates with regards to fusion rates, time to fusion, subsidence, complications, or adjacent-level surgery. Static plating allows for subsidence at similar levels to dynamic plating.

References

  • 1 Bohlman H H, Emery S E, Goodfellow D B. et al . Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy.  J Bone Joint Surg [Am]. 1993;  75 1298-1307
  • 2 Wang J, McDonough P, Endow K. et al . Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion.  Spine. 2000;  25 21-25
  • 3 Emery S E, Bolesta M J, Banks M A. et al . Robinson anterior cervical fusion: Comparison of standard and modified techniques.  Spine. 1994;  19 660-663
  • 4 Samartzis D, Shen F H, Lyon C. et al . Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion?.  Spine J. 2004;  4 636-643
  • 5 Brodke D S, Gollogly S, Alexander Mohr R. et al . Dynamic cervical plates: Biomechanical evaluation of load sharing and stiffness.  Spine. 2001;  26 1324-1329
  • 6 Rapoff A J, O'Brien T J, Ghanayem A J. et al . Anterior cervical graft and plate load sharing.  J Spinal Disord. 1999;  12 45-49
  • 7 DuBois C M, Bolt P M, Todd A G. et al . Static versus dynamic plating for multilevel anterior cervical discetomy and fusion.  Spine J. 2007;  7 (2) 188-193
  • 8 Nunley P D, Jawahar A, Kerr E J. et al . Choice of plate may affect outcomes for single versus multilevel ACDF: results of a prospective randomized single blind trial.  Spine J. 2009;  9 (2) 121-127