Anterior Fusion with Caspar Plating in Traumatic Cervical Spine Instability

OBJECTIVE: In these retrospective studies, the authors report an evaluation of clinical and radiological outcome in patients with cervical spine injury who underwent anterior cervical fusion with Caspar Plating system. METHODS: The authors studied 45 patients with unstable cervical spine after trauma between July 1996 and December 2001. Our series consist of 39 male and 6 female. The cervical spine injury was most common in men in fourth decade. Motor vehicle accidents were a frequent cause of cervical spine injury. Thirty-three patients had fractures with instablity, ten a ligamental injury without fracture, one traumatic hernated disc. Lateral cervical spine X-rays were reviewed for evaluation of fusion and instrumentation failure. RESULTS: In most cases, operation for stabilization was done around one weeks after trauma. In all patients excellent immediate postoperative stability of the spine was obtained, although posterior fusion was necessary at same time in one patient. Solid fusion was achieved in all except two patients who died during the first 2 months after the operation. Three patients developed instrumentation related failure(6.7%): Two patients had screw loosening, one infection. Two of these patients underwent reoperation. The most dreaded complication of dural or cord penetration by drilling or screw placement was not observed. There was no postoperative neurological disturbances. Four patients died of causes unrelated to operation: Two patients died of upper gasterointestinal bleeding, and the other two died of pneumonia and sepsis respectively. CONCLUSION: The Caspar plating system affords an effective means of improving the fusion rate with acceptable instrumentaton-related morbidity in cervical spine injury.

Results of Cervical Interbody Fusion Using the Anterior Plate System

In order to evaluate long-term effects of the anterior cervical plating system, we report the results of 59 patients who were treated with anterior decompression, autogenous iliac bone graft, and anterior cervical plate. Operations were performed on 59 patients for a variety of reasons; 40 for fracture and/or dislocation, 7 for degenerative spondylosis, 4 for ossification of posterior longitudinal ligament, 5 for pyogenic or tuberculous spondylitis, and 3 for metastatic tumor. Our study consisted of 41 male and 18 female patents whose ages ranged from 14 to 76 years. Immediate fixation was obtained in 56 cases(95%). Satisfactory fusion was obtained in ll but five cases of which the result could not be judged due to death of the patients(3 cases of metastatic disease) and removal of the instrument(2 cases of fracture). Specific complications included 5 cases of screw loosening, 2 cases of screw fracture, 2 cases of dysphagia, and 1 case of esophageal fistula. The anterior plate system is thought to provide a valuable means of treating cervical instabilities.

Clinical Experiences of Anterior Cervical Spine Fusion with the Caspar Plate

The anterior interbody fusion for cervical spine disease may not provide adequate immediate stabilization, but anterior cervical spine plating has overcome this main disadvantage. Between August 1991 and August 1992, twenty patients with a variety of cervical spine abnormalities were treated by anterior cervical spine fusion with the Caspar plate system. Fourteen patients had traumatic fracture and/or dislocation, three had infection(including two tuberculous spondylitis), two had degenerative spondylosis, and on had metastatic tumor. Single level fusion was accomplished in six patients, two-level fusion in eleven patients, and three-level fusion in three patients. Among seventeen patients with an incomplete transverse lesion or neck pain, all patients showed some recovery at discharge except two patients with Frankel grade D. Complications included screw loosening(one patient), dysphagia(one patient, which subsided after removal of the plate), and transient neurological worsening(one patient). All patients had good bony fusion except one which had screw loosening. Careful attention to surgical technique is needed to assure good results.

Clinical Analysis of Anterior Fixation with Caspar Plate in Unstable Cervial Spine

The authors analyzed 19 cases of unstable cervical spine injuries who had been treated by anterolateral approach with Caspar plate at the department of neurosurgery of Hangang Sacred Heart hospital during 3 years from 1989. The results were as follows: 1) The unstable cervical spine injury was most common in 3rd decade of age. Male to female ratio was 3.75:1. 2) Regarding the level of injury, C5-6 injury was most common. 3) The most common cause of injury was fall down from height(47.4%) and the next was traffic accident(36.8). 4) In all cases received anterior reconstructive surgery using Caspar plate showed significant neurologic improvement. 5) In all cases received anterior reconstructive surgery showed a good restoration of cervical spinal stability. 6) The major surgical complication was esophageal fistula and all complications were treated without any sequelae. 7) Anterior reconstructive surgery using Caspar plate is considered one of the surgical options in patient of cervical spine injury with severe instability.