Anterior cervical discectomy and fusion (ACDF) is a well-established spinal operation for cervical disc degeneration disease with neurological compromise. The procedure involves an anterior approach to the cervical spine with discectomy to relieve the pressure on the impinged spinal cord to slow disease progression. The prosthetic cage replaces the disc and can be inserted stand-alone or with an anterior plate that provides additional stability. The literature demonstrates that the cage-alone (CA) is given preference over the cage-plate (CP) technique due to better clinical outcomes, reduced operation time and resultant morbidity. This retrospective case-controlled study compared CA versus CP fixation used in single and multilevel anterior cervical discectomy and fusion for myelopathy in a tertiary centre in Wales. A retrospective clinico-radiological analysis was undertaken, following ACDF procedures over seven years in a single tertiary centre. Inclusion criteria were patients over 18 years of age with cervical myelopathy who had at least six-month follow-up data. SPSS was used to identify any statistically significant difference between both groups. The data were analysed to evaluate the consistency of our findings in comparison to published literature. Eighty-six patients formed the study cohort; 28 [33%] underwent ACDF with CA and 58 [67%] with CP. The patient demographics were similar in both groups, and fusion was observed in all individuals. There was no statistical difference between the two constructs when assessing subsidence, clinical complication (dysphagia, dysphonia, infection), radiological parameters and reoperations. However, a more significant percentage [43% v 61%] of patients improved their cervical lordosis angle with CP treatment. Furthermore, the study yielded that surgery to upper cervical levels results in a higher incidence of
Introduction. Recently ventral plating implants made of carbon/PEEK composite material have been developed with apparently superior material properties in terms of implant fatigue and imaging suitability. In this study we assessed the outcome of the first clinical application of this new implant. Methods. Retrospective, single-center case series of 16 consecutive patients between 2011 and 2013 undergoing ventral stabilization surgery with a new carbon plating system (see figure 1). We collected data in terms of safety of the procedure (screw positioning, blood loss, operation time), quality and reliability of the implant (revisions, dislocations, screw loosening, fusion, adjacent segment degeneration), clinical outcome and biological tolerance (cervical pain / discomfort, dysphagia). Results. All patients were available for clinical and radiological follow up. Mean surgery time was 128 minutes, in 11 cases one in 5 cases 2 segments were treated. The clinical findings and patient's satisfaction were good in 14 and fair in two cases. All patients who completed the 6 months control had a radiographically confirmed interbody fusion; no implant loosening or failure and no infections were observed. (see figure 2). There was one implant related complication (dysphagia due to malpositioning of the plate which was removed 4 days after implant insertion) and one complication related to the approach (Horner's syndrome). Conclusion. In this retrospective study of 16 patients we found that the use of a carbon-composite plating system lead to results comparable to the “gold standard” metal plates in terms of safety / clinical outcome and reliability of the implant. There was one revision due to
Introduction. Anterior reconstruction has the advantage of conferring immediate stability to the cervico-thoracic junction. Aims and objectives. Assess clinical and radiological outcome in cervico-thoracic kyphosis treated with anterior reconstruction. Material and methods. 62 cases were treated with anterior reconstruction from 1996-2007. Minimum follow-up was 2years (2-6). Indications included tuberculosis (45), dysplastic(10), neoplastic (3) and traumatic (4). Average age was 28.6 years (13-72 years). Average pre-operative kyphosis was 26.4 degrees (5-84). Patients were grouped as long-neck (35) and short-neck (27) according to classification proposed by Bapat and Laheri. The caudal normal vertebra (CNV) matched on plain radiology and MRI in 40 (64.51%). In 22 level of fixation was extended due to poor bone mass in the adjacent vertebral body (caudal 17, cranial 5). Pre-operative neurological deficit was seen in 57 (91.3%) and average Nurick's grade was 3.8 (0-5). Results. 32 long-neck patients required strap-muscle tenotomy to expose the CNV. In 3(9.3%) manubriotomy was required (large neck girth 1, thyroid goitre 2). 26 short-neck patients required manubriotomy for plate placement. In 42 (67.8%) patients a standard anterior cervical plate was used. In 22 locking plate was used. Commonest cranial and caudal vertebrae instrumented were C7 (32) and T2 (20) respectively. Post-operative kyphosis averaged 14.68 degrees (0-78) and correction averaged 11.72 degrees. Average post-operative Nurick's grade was 2.8. One patient with fracture dislocation of T1-T2 and traumatic oesophageal rupture died. In 1 the implant loosened and was revised with posterior construct. In 1, screw loosening was observed but implant position remained unaltered. 2 patients had recurrent laryngeal palsy. Iatrogenic pleural rent occurred in 2 patients. Transient
