A Case of Hypopharyngeal Perforation after Anterior Cervical Plate Fixation

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

Download Full-text

Early Failure of Long Segment Anterior Cervical Plate Fixation

Journal of Spinal Disorders ◽

10.1097/00002517-199810000-00008 ◽

1998 ◽

Vol 11 (5) ◽

pp. 410???415 ◽

Cited By ~ 128

Author(s):

Alexander R. Vaccaro ◽

Stephen P. Falatyn ◽

Gaetano J. Scuderi ◽

Frank J. Eismont ◽

Robert A. McGuire ◽

...

Keyword(s):

Plate Fixation ◽

Early Failure ◽

Cervical Plate ◽

Anterior Cervical Plate

Download Full-text

Effectiveness of cemented rescue screws for anterior cervical plate fixation

Journal of Neurosurgery Spine ◽

10.3171/spi.2006.4.1.60 ◽

2006 ◽

Vol 4 (1) ◽

pp. 60-63 ◽

Cited By ~ 9

Author(s):

Tobias Rainer Pitzen ◽

Jörg Drumm ◽

Bernhard Bruchmann ◽

Dragos Doru Barbier ◽

Wolf-Ingo Steudel

Keyword(s):

Bone Cement ◽

Sagittal Plane ◽

Plate Fixation ◽

Peak Torque ◽

Fixation Strength ◽

Mineral Density ◽

Pullout Force ◽

The Mean ◽

Cervical Plate ◽

Anterior Cervical Plate

Object Among the various ways to optimize the fixation of bone implants is to use bone cement, for example, in a total hip prosthesis. No data exist, however, concerning the effectiveness of cemented rescue screws for anterior cervical plate fixation. The aim of this study was to investigate whether cemented rescue screws increase fixation strength in comparison with uncemented standard screws. Methods Six cervical spine segments (C4–7) were explanted during routine autopsy studies from fresh human cadavers. Bone mineral density (BMD) was measured for each vertebral body (VB) using quantitative computerized tomography scanning, and 24 VBs were dissected from the segments. Two initial pilot holes were drilled into each VB parallel to the sagittal plane. Based on their BMD, the specimens were assigned to one of two groups in which torque and pullout force were tested. The test was begun with standard screws and was repeated with cannulated slotted rescue screws into which bone cement was injected. The mean values of peak torque and pullout forces resulting from the left and right measurements were used for statistical analysis. A t-test was performed to determine the effect of screw type on peak torque and pullout force. Moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force for each type of screw. The mean insertional peak torque was 67.1 N/cm for the standard screw and 102.6 N/cm for the cemented screw (p < 0.05). The mean pullout force was 526.9 N for standard osteoporosis screws and 531.5 N for cemented screws (p > 0.05). The effect of increased holding strength as measured by peak torque and pullout force was more pronounced in the presence of low bone density. Conclusions Cemented rescue screws that have been inserted into a fatigued pilot hole in the cervical VB strengthen the screw–bone interface compared with the strength initially conferred by a standard screw.

Download Full-text

The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review

The Open Orthopaedics Journal ◽

10.2174/1874325001206010121 ◽

2012 ◽

Vol 6 (1) ◽

pp. 121-128 ◽

Cited By ~ 7

Author(s):

Ricardo Vieira Botelho ◽

Yuri dos Santos Buscariolli ◽

Marcus Vinicius Flores de Barros Vasconcelos Fernandes Serra ◽

Marcia Nogueira Pires Bellini ◽

Wanderley Marques Bernardo

Keyword(s):

Randomized Trials ◽

Plate Fixation ◽

Clinical Results ◽

Limited Evidence ◽

Moderate Evidence ◽

Intervertebral Disc Height ◽

Central Registry ◽

Cervical Plate ◽

Intervertebral Cage ◽

Anterior Cervical Plate

Background: The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height. Objective: The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI). Methods: randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE. Results: Seven studies were selected for analysis. Conclusion: Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD. There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.

Download Full-text