title: Bioabsorbable anterior cervical plate fixation for single-level degenerative disorders: early clinical and radiographic experience.
abstract: BACKGROUND
  Increased fusion rates have been reported with the addition of an anterior cervical plate (ACP) to anterior cervical discectomy and fusion (ACDF). Bioabsorbable implants have become increasingly used in orthopedic and spine surgical procedures. There are limited data regarding the outcomes of bioabsorbable ACP (bACP) with ACDF.
  
  
  OBJECTIVE
  To compare the clinical and radiographic outcomes of patients undergoing ACDF for single-level degenerative disorders with a bACP versus a conventional metal ACP (mACP).
  
  
  METHODS
  Retrospective comparative cohort study.
  
  
  METHODS
  Thirty-one patients undergoing ACDF for a single-level degenerative disorder (ie, disc herniation or spondylotic neural compression).
  
  
  METHODS
  Incidence of early (within 2 weeks) complications, postoperative sagittal alignment, Odom's criteria, and pseudarthrosis rate.
  
  
  METHODS
  The authors retrospectively reviewed the results of a consecutive series of patients undergoing ACDF for symptomatic single-level disc herniation or spondylotic neural compression with either a bACP or an mACP over a 3-year period. Operative notes, clinical charts, and radiographs were analyzed. Radiographic outcomes were assessed for intersegmental alignment, graft subsidence, fusion rate, prevertebral soft-tissue shadow, and graft containment. Clinical outcome was evaluated by Odom's criteria.
  
  
  RESULTS
  Fourteen patients underwent ACDF with a bACP and 15 with an mACP. Radiographic outcomes at the most recent follow-up demonstrated pseudarthrosis in 4 of 14 patients (29%) in the bACP group and 0 of 15 patients in the mACP group. Graft extrusion and anterior displacement was present in three of four pseudarthroses (75%). Comparing preoperative and final radiographs, cervical lordosis was maintained at the operative segment in only 3 of 14 bACP patients (21%) compared with 8 of 15 patients (53%) in the mACP group. The mean Cobb angle was 2.4°±1.9° lordosis in the mACP group and -2.7°±2.5° kyphosis in the bACP group (p=.12). In the mACP group, 14 of 15 patients had good or excellent results. In the bACP group, only 7 of 14 patients had good or excellent results.
  
  
  CONCLUSIONS
  Bioabsorbable ACP fixation was associated with a high rate of graft extrusion and early loss of intersegmental cervical alignment. Inferior clinical outcomes were observed in patients in the bACP group compared with the mACP group. Based on these findings, continued use of the bACP used in this study cannot be recommended.
authors: Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA.
authors: Darren R
authors: DR
authors: Lebl
authors: Christopher M
authors: CM
authors: Bono
authors: Umesh S
authors: US
authors: Metkar
authors: Brian E
authors: BE
authors: Grottkau
authors: Kirkham B
authors: KB
authors: Wood
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates / Q000009:adverse effects*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*