Initial intervertebral stability after anterior cervical discectomy and fusion with plating.
BACKGROUND
Anterior cervical locking plates are currently used to provide secure fixation, which appears to help promote fusion, although the details of the in vivo biomechanical effects of plating on the spine are unknown.


OBJECTIVE
To determine if any motion was present initially in the plated anterior cervical discectomy and fusion (ACDF) and, if so, where the motion occurred.


METHODS
A cohort of patients that were part of a prospective study on postoperative changes after cervical fusion were evaluated for motion at the fusion site about 2 weeks after ACDF.


METHODS
Forty-eight segments in 27 patients undergoing ACDF with a cervical plate were evaluated. The patients underwent flexion and extension radiography approximately 2 weeks after surgery. Intervertebral motion at the fusion site was evaluated with validated quantitative motion analysis.


RESULTS
Motion was perceived at 29 levels in 18 patients. The sources of motion were either actual bending of the plate itself, motion at the screw-bone interface, or screw-plate interface.


CONCLUSIONS
In many patients, anterior cervical plating after ACDF does not eliminate motion at the fusion site. Depending on the quality of bone, type of bone graft, and nature of the injury, this information may influence decisions regarding implants and postoperative bracing.
Mourning
David
D
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Reitman
Charles A
CA
Heggeness
Michael H
MH
Esses
Stephen I
SI
Hipp
John A
JA
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000502:physiology / Q000601:surgery*; D017586:Diskectomy / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009068:Movement; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D016896:Treatment Outcome