Does Dynamic Ventral Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures in Mid-term Follow-up?
Abstract BackgroundIt remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with a dynamic plate compared to rigid locking plate system.Patients and MethodsPatients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. Only patients with complete radiological follow (pre- and postoperatively and minimum one year after surgery) were included in the study. Next to the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years the patient reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36) with the physical components summary (PCS) and mental components summary (MCS), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) score.Results33 patients met the in- and exclusion criteria. 26 patients suffered from an AO Type B or C fracture. 13 patients were treated with a dynamic plate and 20 with a rigid locking plate. Both, the sagittal alignment, and the sagittal translation could be sufficiently restored with no differences between the two groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (91%) with no significant differences between both groups (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients PROMs could be evaluated after a mean follow-up of 71.2±25.5 months. No significant differences between DP and RP could be detected in EQ-5D, SF- 36 (PCS and MCS) or NDI (EQ-5D: 72±5; SF-36 PCS 41.9±16.2, MCS 45.4±14.9; NDI: 11±9).ConclusionThe dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered AO Type B and C fractures.