A Comparative Analysis of Plate/Graft Failure with Correction Following Circumferential Cervical Spinal Surgery

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概要

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• Object : To evaluate the incidence of failure of fixed versus dynamic plates following multilevel circumferential cervical procedures addressing multilevel ossification of the posterior longitudinal ligament and spondylostenosis. Two to four level anterior cervical corpectomy with fusion (ACF) was accompanied by simultaneous C2-T1 posterior wiring and fusion (PWF). Methods : Fixed Plating System "Constrained" Orion (Sofamor Danek, Memphis, TN, USA) plates, employing a fixed plate/fixed screw design, were applied in 2 level ACF (6 patients), 3 level ACF (14 patients), and 4 level ACF (2 patients)."Semiconstrained" Atlantis plates (Sofamor Danek, Memphis, TN, USA), utilizing a fixed plate/variable screw design, were used in the next 16 patients undergoing 2 level ACF (5 patients), 3 level ACF (9 patients), and 4 level ACF (2 patients). Orion plated patients had iliac crest autografts while Atlantis plated received fibula strut allografts. The integrity of the graft and plate, as well as the status of the fusion, was documented on static X-rays at four week intervals, with dynamic X-rays and 2D CT studies ordered three, six, and 12 months postoperatively. Dynamic Plating System In addition, 25 comparable patients undergoing 2 level ACF (11 patients), 3 level ACF (9 patients), and 4 level ACF (2 patients) combined with PWF received dynamic ABC plates (Aesculap, Tuttlingen, Germany). Results : Two Orion plates and three Atlantis plates failed (13%). One of the two Orion plates which extruded inferiorly was removed six months postoperatively for persistent dysphagia, while all three Atlantis plates which extruded inferiorly along with the grafts required urgent anterior plate and graft replacement. Only one of the 25 patients receiving ABC plates required a secondary PWF for partial pseudarthrosis 6 months postoperatively. Conclusions : Fixed plate failures, encountered in 13% of circumferential procedures, were largely attributed to increased graft shielding with reduced graft compression, while the success of dynamic plates was primarily due to reduced graft shielding and increased graft settling.

• 日本脊髄外科学会の論文
• 2002-03-31

著者

• Epstein Nancy

  Department Of Neurological Surgery Albert Einstein College Of Medicine

• Epstein Nancy

  Department Of Neurosurgery:department Of Neurosurgery North Shore-long Island Jewish Health System M

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• A Comparative Analysis of Plate/Graft Failure with Correction Following Circumferential Cervical Spinal Surgery

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