Abstract
Background context
The proximity (<5 mm) of the plate to the adjacent disc space is known to be a critical
risk factor for adjacent-level ossification development (ALOD). As plates provide
many advantages including higher fusion rates and improved alignment, their use will
continue. Instead, it is necessary to modify the plating techniques to minimize this
complication.
Purpose
To determine if our newer plating technique decreases the incidence of ALOD after
anterior cervical plating.
Study design
Retrospective matched cohort analysis of preoperative and postoperative radiographic
data.
Patient sample
One hundred patients were classified into two groups; conventional (C) and new (N)
plating techniques. The control group (Group C) was matched to the study group (Group
N) in a 1:1 fashion using matching criteria of age (within 5 years), gender, number
of fusion levels, and comorbidities, including diabetes and tobacco use.
Outcome measures
The lateral plain X-rays of cervical spine taken at postoperative 6 months and 2 years
were used for analysis.
Methods
In Group N, the cranial and caudal screws were started at the anterior end plate corners
and angled away from the end plates so as to use the shortest possible plate and maximize
the distance to the adjacent end plates. Group C was the historical control using
a longer plate with more orthogonal screw angulation. On postoperative 6-week lateral
films, the distances from the tip of the plate to both cranial and caudal adjacent
discs (plate-to-disc distances) were measured. Based on the postoperative 2-year radiographs,
the incidence of ALOD was determined, and the severity of ossification was classified
on a scale ranging from Grade 0 (no ossification) to Grade 3 (complete bridging).
Results
Mean plate-to-disc distances in Group N were significantly longer at both cranial
and caudal adjacent levels than those in Group C (p<.001). The incidence of ALOD was
significantly lower in Group N than in Group C, both at the cranial adjacent disc
spaces (42% vs. 72%) and caudal adjacent disc spaces (20% vs. 42%) (p<.05). Severe
ossification (Grade 2 or greater) also developed less frequently in Group N at cranial
and caudal levels (6% vs. 20%, respectively; p<.05).
Conclusions
The new technique of using a shorter plate with longer angulated screws resulted in
significantly reduced incidence and severity of ALOD.
Keywords
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Article info
Publication history
Published online: April 19, 2013
Accepted:
March 7,
2013
Received in revised form:
November 26,
2012
Received:
January 21,
2011
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: D-HL: Nothing to disclose. J-SL: Nothing to disclose. J-SY: Nothing to disclose. WC: Nothing to disclose. LPZ: Nothing to disclose. KDR: Royalties: EBI/Biomet (F), Osprey (C), Medtronic Sofamor Danek (G); Stock Ownership: Osprey (10 shares, 0%), Expanding Orthopedics (approximately 10,000 shares, 1%, no viable products), Spineology (B, <1%), Spinal Kinetics (C, <1%), Nexgen Spine (B, <1%), Amedica (B, <1%), Vertiflex (B, <1%), Benvenue (C, <1%), Paradigm Spine (B, <1%), PSD (B, <1%); Board of Directors: Korean Association of Spinal Surgeons (none), Cervical Spine Research Society (none); Relationships Outside the One-Year Requirement: Medtronic (08/2009, Consulting, F).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
