Three-level Anterior Cervical Discectomy and Fusion with Cervical Plate / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes by the method of three-level anterior cervical discectomy and fusion with cervical plate. SUMMARY OF LITERATURE REVIEW: The arthrodesis rate and outcome for patients having three-level anterior cervical discectomy and fusion procedures is disappointing. The success of arthrodesis depends on several factors including bone graft type, size, and additional anterior plate fixation. MATERIALS AND METHODS: Five patients (average age, 69 years; all males) were observed. All had a anterior discectomy, placement of autogenous tricortical iliac bone graft at three-levels and application of a Orion plate. Clinical and radiologic results of bony union, cervical lordosis and intervertebral disc height were assessed. RESULTS: All clinical symptoms of patients had been resolved after operation. The postoperative scores by the criteria of Odom are 2 in excellent and 3 in good. The bony unions were achieved in all cases in the average 12 weeks after surgery (minimum 8 weeks, maximum 20 weeks). The sum of three-level intervertebral disc height in average was increased from 14.8 mm preoperatively to 25.4 mm postoperatively. The average angle of cervical lordosis was corrected from 18o preoperatively to 27o postoperatively. CONCLUSIONS: The three-level anterior cervical discectomy and fusion with Orion plate and autogenous tricortical iliac bone graft results in effective surgical treatment, which produces good clinical outcome, early and solid bony union, restoration of the normal cervical lordosis and disc space height.

Prognostic Factors of Locking Unicortical System in Internal Fixation for Cervical Spine Lesions

Although anterior cervical plate provide excellent fixation for anterior column, the potential risk for injury to spinal cord or soft tissue has been the reason why they have not gained universal acceptance. For this reason, anterior cervical locking plating systems were designed to avoid such surgical complications. The authors reviewed 98 patients who underwent anterior cervical fusion with anterior cervical locking unicortical system during the period of January 1995 to December 1997. Mean follow up period was 8.4months. Morscher plate placement was done in 24 and Orion plate was applied in 74. We compare the safety and efficacy of these tow plates. The two groups were comparable in demographic details, mean age(Morscher 41, Orion 47) average fusion level(Morscher 1.25, Orion 1.55) and fusion rate(Morscher 95.8%, Orion 100%). For comparison of hardware related complication, two patients(2.7%) showed screw loosening without without need for reoperation in Orion plate group. In Morscher plate group, 1 patient(4.1%) developed plate fracture and 1 patient (4.1%) developed screw loosening, but did not require delete(re) operation. Non-hardware related complications in Morscher group were seen in 2 patients(8.2%): one delete CSF leakage and the other being postoperative hematoma collection. In Orion plate group, complications were developed in 9 patients(12%): two nerve injuries(recurrent laryngeal and hypoglossal nerve), two CSF leakages, two wound infections, one postoperative hematoma collection, two donor graft site pains. Reoperations were done in two cases(2%) due to two postoperative hematoma collection one in Morscher plate group and one in Orion plate group. In one level fusion, longer operation time was required in Morscher plate group(217+/-93.7min) compared to Orion plate group(157+/-47min)(p<0.05). In this study two types of anterior cervical locking plate and screw system had good bony fusion and cervical stabilization with few instrument related complication. Moreover, allograft bone fusion with anterior cervical locking plate and screw system had good solid bony fusion without donor site morbidity. Instrument related complications were more common in Morscher locking plate and screw system.

Anterior Cervical Fusion with New Angled Locking Screw for Cervical Spine Injury: Preliminary Report

Although anterior cervical plates provide excellent fixation for the anterior column, the potential risk for injury to the spinal cord or soft tissue has been the reason why they have not gained universal acceptance, new angled locking screw was designed to avoid such surgical complications. We are intending of anterior cervical fusion by means of new angled locking screw Orion Plate and also suggest that Orion Plate System is mandatory for reducing technical demands and late instrumentation failure.