Angular Stable Plates in Lower Cervical Spine Fractures

Abstract

This study evaluates the results of operative treatment of lower cervical spine injuries stabilised with angular stable plates and screws. It is a retrospective study of anterior spondylodesis carried out to stabilise unstable lower cervical spine injuries. From 1994 to 2001, 131 anterior spondylodeses were performed. One segment was fused in 116 (88.5 %) cases and two segments were fused in 15 (11.5 %) cases. Preoperative realignment was achieved by halo traction followed by operative decompression and stabilisation. Ruptured discs or fractured vertebral bodies were removed and fusion was performed using tricortical autologous bone grafts with angular stable plates and screw fixation. In 131 cases of anterior spondylodesis, 125 (95.4 %) fused solidly in an average of 3.4 months. In 4 (3 %) cases pseudarthrosis occurred and in 2 (2.5 %) cases dislocation of instrumentation was found. All cases of pseudarthrosis required further surgery. Repeated plate breakage occurred in one patient but due to the absence of clinical signs or symptoms of instability no further surgery was performed. In the 2 cases of dislocation of screws and plates, reosteosynthesis resulted in solid fusion. Both of these patients suffered from ankylosing spondylitis. Our results of fusion (95.4 %) using angular stable plates and screws are comparable to other results available in the literature. The reason for the occurrence of pseudarthrosis is not clear. Early and over vigorous physical exercise may contribute. In patients with ankylosing spondylitis, reduced bone quality probably caused the dislocation of screws and the resulting non-union.

cervical spine fractures - anterior spondylodesis - angular stable plate fixation

References

• 1 Adams M S, Crawford N R, Chamberlain R H, Sonntag V K, Dickman C A. Biomechanical comparison of anterior cervical plating and combined anterior/lateral mass plating.  Spine J. 2001;  1 166-170
• 2 Aebi M, Mohler J, Zach G A, Morcher E. Indication, surgical technique and results of 100 surgically treated fractures and fracture-dislocations of the cervical spine.  Clin Orthop. 1986;  203 244-257
• 3 Aebi M, Zuber K, Marchesi D. Treatment of cervical spine injuries with anterior plating.  Indications, techniques, and results.. Spine1991;  16 S 38-S 45
• 4 Bailey R W, Badgeley C E. Stabilization of the cervical spine by anterior fusion.  J Bone Joint Surg [Am]. 1960;  42 565-594
• 5 Böhler J, Gaudernak T. Anterior plate stabilization for fracture-dislocation of the lower cervical spine.  J Trauma. 1980;  20 203-205
• 6 Bohlmann H H. Acute fractures and dislocations of the cervical spine: An analysis of three hundred hospitalized patients and review of the literature.  J Bone Joint Surg [Am]. 1979;  61 1119-1142
• 7 Cybulski G R, Douglas R A, Meyer P R, Rovin R A. Complications in three-column cervical spine injuries requiring anterior-posterior stabilization.  Spine. 1992;  3 253-256
• 8 Castaing J. Traitment chirurgical par voie antérieur dans les traumatismes récents du rachis cervical inférieur.  Rev Chir Orthop. 1984;  70 519-522
• 9 Castaing J. Arguments en faveur de la voie antérieure dans la chirurgie traumatique du rachis cervical.  Rev Chir Orthop. 1984;  70 556-557
• 10 Daentzer D, Boker D K. Operative stabilization of traumatic instabilities of the lower cervical spine. Experience with an angle instable anterior plate-screw system in 95 patients.  Unfallchirurg. 2004;  107 175-180
• 11 Gassman J, Seligson D. The anterior cervical plate.  Spine. 1983;  8 700-707
• 12 Kaiser M G, Haid R W, Subach B R, Barnes B, Rodts G E. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft.  Neurosurgery. 2002;  50 229-236
• 13 Louis R. Les théories de l'instabilité.  Rev Chir Orthop. 1977;  63 423-425
• 14 Morcher E, Sutter F, Jennis M, Olerud S. Die vordere Verplattung der Halswirbelsäule mit dem Hohlschraubenplattensystem.  Der Chirurg. 1986;  57 702-707
• 15 Razack N, Green B A, Levi A D. The management of traumatic cervical bilateral facet fracture-dislocations with unicortical anterior plates.  J Spinal Disord. 2000;  13 374-381
• 16 Ripa D R, Kowall M G, Meyer P R, Rusin J J. Series of ninety-two traumatic cervical spine injuries stabilized with anterior ASIF plate fusion technique.  Spine. 1991;  16 S 46-S 55
• 17 Robinson R A, Walker A E, Ferlic D C. et al . The results of anterior interbody fusion of the cervical spine.  J Bone Joint Surg [Am]. 1962;  44 1569-1586
• 18 Roy-Camille R. Arguments en faveur de la voie posterieure dans la chirurgie traumatique du rachis cervical.  Rev Chir Orthop. 1984;  70 550-555
• 19 Stulik J, Krbec M, Vyskocil T. Injuries of the lower cervical vertebrae - the monocortical technique.  Acta Chir Orthop Traumatol Czech. 2003;  70 226-232
• 20 Suh P B, Kostuik J P, Esses S I. Anterior cervical plate fixation with the titanium hollow screw plate system. A preliminary report.  Spine. 1990;  15 1079-1081