title: Plate fixation in the cervical spine: traditional paramedian screw configuration compared with unique unilateral configuration.
abstract: OBJECTIVE
  This study compared the fixing strength and stability achieved by a unilateral plate and screw configuration against a standard cervical fixation plate using a single-level corpectomy and allograft strut graft model.
  
  
  METHODS
  Multidirectional in vitro flexibility tests were performed using a robotic spine testing system. Human cadaveric spines were assessed for spinal stability after vertebral corpectomy and anterior instrumentation. Specimens were mounted cranially and caudally on custom jigs that were then attached to load cells on the robotic system's end effector and base pedestal. C2-T1 spine specimens (n = 6) were tested intact; then after C-5 corpectomy (the vertebral body was excised), allograft placement and anterior plate fixation were performed. The surgeons performed a uniform corpectomy and reconstruction of each specimen in a protocol fashion. Two plates were compared: a unilateral 4-hole cervical plate designed to obtain rigid fixation using 4 convergent fixation screws all placed unilateral to the vertebral midline, and a standard cervical plate with bilateral plate screw configuration. The plate testing sequence was selected at random to limit bias. Fixation screws were matched for length and diameter. Pure moments were applied under load control (maximum 1.8 Nm) in flexion, extension, left/right lateral bending, and left/right axial rotation. Vertebral motion was measured using an optoelectronic system. The mean relative range of motion between C-4 and C-6 was compared among groups using repeated-measures ANOVA (significance level of 0.05).
  
  
  RESULTS
  In comparing the intact construct and 2 different plates in all planes of motion, only motion in extension (intact vs. unilateral plate, p = 0.003; intact vs. standard plate, p = 0.001) and left axial rotation (intact vs unilateral plate, p = 0.019) were significantly affected. In terms of immediate cervical stability after 1-level corpectomy and placement of an allograft reconstruction, the unilateral plate showed comparable stiffness to the standard plate in all 3 motion planes (flexion [p = 0.993], extension [p = 0.732], left lateral bending [p = 0.683], right lateral bending [p = 0.546], left axial rotation [p = 0.082], and right axial rotation [p = 0.489]). The unilateral plate showed a trend toward improved stiffness in axial rotation. In no direction did the unilateral configuration prove significantly less stiff than the traditional configuration.
  
  
  CONCLUSIONS
  The unilateral plate design proposed here requires minimal dissection and retraction beyond the midline of tissues susceptible to scar, postoperative pain, and swelling. The authors' study suggests that a unilateral plate can be configured to provide comparable fixation strength and torsional stiffness compared with traditional, widely accepted plate designs.
authors.affiliation: Spine Research Lab, Lutheran Hospital, Cleveland Clinic Center for Spine Health, Cleveland, Ohio, USA.
authors.forename: Prasath
authors.initials: P
authors.lastname: Mageswaran
authors.forename: Robert F
authors.initials: RF
authors.lastname: McLain
authors.forename: Robb
authors.initials: R
authors.lastname: Colbrunn
authors.forename: Tara
authors.initials: T
authors.lastname: Bonner
authors.forename: Elijah
authors.initials: E
authors.lastname: Hothem
authors.forename: Adam
authors.initials: A
authors.lastname: Bartsch
mesh_terms: D000368:Aged; D001860:Bone Plates / Q000592:standards*; D001863:Bone Screws / Q000592:standards*; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016059:Range of Motion, Articular / Q000502:physiology*; D012371:Robotics / Q000379:methods*