Dynamic Plating for Single Level Anterior Diskectomy/Fusion:

Abstract

The morbidity for dynamic plating [ABC Aesculap, Tuttlingen, Germany] of 116 single level anterior cervical corpectomy/fusion [1 ACF] procedures included delayed graft fractures [2 of 7 surgical], graft/plate extrusion [one], pseudarthroses [two], and adjacent segment disease warranting secondary surgery [one][6]. Here we asked what morbidity would be encountered utilizing dynamic plates for 31 single level anterior diskectomy and fusion procedures. Thirty-one patients undergoing 1 level ADF averaged 45 years of age and included 18 males, 13 females, and 12 smokers [Table I]. Patients exhibited moderate myelopathy attributed to MR/CT documented disc herniations [ten], spurs/ossification of the posterior longitudinal ligament [OPLL] [seven], or both [fourteen]. Iliac crest autografts, dynamic plates, and cervicothoracic orthoses [CTO] were utilized [until fused]. Patients were followed an average of 2.6 years [minimum 1 year]. Two independent neuroradiologists confirmed fusion utilizing both dynamic X-rays and 2D-CT studies [2.5-12 mo postoperatively]. SF-36 outcomes were also assessed [preoperatively- 1 year postoperatively]. Postoperatively, patients’ myelopathy improved an average of 3 Nurick Grades. Although all patients fused [dynamic X-ray/2D-CT] an average of 3.6 months postoperatively, 2 female smokers demonstrated delayed fusions [7, 8 months], and one required secondary surgery 5 years later for adjacent level disease. Utilizing dynamic plates, although all 31 single level ADF patients fused [average 3.6 months postoperatively], 2 demonstrated delayed fusions [7, 8 months], and one developed adjacent segment disease 5 years later warranting secondary arthrodesis. None, however, developed the delayed fractures, graft/plate extrusion, or pseudarthroses observed in the previous dynamic-plated 1 level ACF series.