Constrained: Locked screws and no construct motion
Semiconstrained: Locked screws but construct motion allowed
Rotational: Rotational motion allowed at screw/plate interface
Translational: Rotational and translational motion allowed at screw/plate interface
Unrestricted backout no longer utilized
Caspar and Orozco plate systems in the 1980s
Required bicortical screw purchase
Nonlocking and rigid systems with screw angulation determined by surgeon preference
Complications
High rates of screw backout and breakage
Graft subsidence
Risk of neural injury with bicortical purchase
Restricted backout: Constrained plates
Archetype is Synthes cervical spine locking plate (CSLP) (Synthes)
Introduced into USA in early 1990s
Other type is Orion plating system
Does not require bicortical purchase
Titanium expansion screw fixes screw to plate
Ease of application
No need for C-arm fluoroscopy since unicortical
Rare screw backout
Restricted backout: Semiconstrained plates
Rotational: Codman system
Variability in screw direction allowed, with cam-locking system to prevent screw backout
Complications
With multilevel constructs, rotation can lead to graft dislodgement
Translational: DOC plate system (Acromed), ABC system (Aesculap)
DOC: Screws do not pivot but slide along a rail
ABC: Screws translate in a slot and may then rotate after maximum translation
PRE-PROCEDURE
Indications
POST-PROCEDURE
Expected Outcome
Selected References
Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
Aebi M: Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J. 19 Suppl 1:S33-9, 2010
Cagli S et al: Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg. 19(4):437-40, 2009
Solerio D et al: Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating. Eur Spine J. 17 Suppl 2:S280-4, 2008
Fountas KN et al: Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 32(21):2310-7, 2007
Koller H et al: 4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results. Eur Spine J. 16(12):2055-71, 2007
Resnick DK et al: Use of ventral plates for cervical arthrodesis. Neurosurgery. 60(1 Supp1 1):S112-7, 2007
Angevine PD et al: Cost-effectiveness of single-level anterior cervical discectomy and fusion for cervical spondylosis. Spine (Phila Pa 1976). 30(17):1989-97, 2005
Rhee JM et al: Indications and techniques for anterior cervical plating. Neurol India. 53(4):433-9, 2005
Moftakhar R et al: Anterior cervical plates: a historical perspective. Neurosurg Focus. 16(1):E8, 2004
Haid RW et al: The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 12(1):E15, 2002
DiAngelo DJ et al: Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine (Phila Pa 1976). 25(7):783-95, 2000
Kirkpatrick JS et al: Reconstruction after multilevel corpectomy in the cervical spine. A sagittal plane biomechanical study. Spine (Phila Pa 1976). 24(12):1186-90; discussion 1191, 1999
Panjabi MM et al: Loosening at the screw-vertebra junction in multilevel anterior cervical plate constructs. Spine (Phila Pa 1976). 24(22):2383-8, 1999
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Pre-Procedure
TERMINOLOGY
Abbreviations
Anterior cervical plate (ACP)
Anterior cervical discectomy and fusion (ACDF)
Synonyms
Ventral cervical plates
Plate Types
Unrestricted backout devices
Bicortical, nonlocked screws
Restricted backout devices
Unicortical, locked screws
Constrained: Locked screws and no construct motion
Semiconstrained: Locked screws but construct motion allowed
Rotational: Rotational motion allowed at screw/plate interface
Translational: Rotational and translational motion allowed at screw/plate interface
Unrestricted backout no longer utilized
Caspar and Orozco plate systems in the 1980s
Required bicortical screw purchase
Nonlocking and rigid systems with screw angulation determined by surgeon preference
Complications
High rates of screw backout and breakage
Graft subsidence
Risk of neural injury with bicortical purchase
Restricted backout: Constrained plates
Archetype is Synthes cervical spine locking plate (CSLP) (Synthes)
Introduced into USA in early 1990s
Other type is Orion plating system
Does not require bicortical purchase
Titanium expansion screw fixes screw to plate
Ease of application
No need for C-arm fluoroscopy since unicortical
Rare screw backout
Restricted backout: Semiconstrained plates
Rotational: Codman system
Variability in screw direction allowed, with cam-locking system to prevent screw backout
Complications
With multilevel constructs, rotation can lead to graft dislodgement
Translational: DOC plate system (Acromed), ABC system (Aesculap)
DOC: Screws do not pivot but slide along a rail
ABC: Screws translate in a slot and may then rotate after maximum translation
PRE-PROCEDURE
Indications
POST-PROCEDURE
Expected Outcome
Selected References
Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
Aebi M: Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J. 19 Suppl 1:S33-9, 2010
Cagli S et al: Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg. 19(4):437-40, 2009
Solerio D et al: Successful surgical management of a delayed pharyngo-esophageal perforation after anterior cervical spine plating. Eur Spine J. 17 Suppl 2:S280-4, 2008
Fountas KN et al: Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 32(21):2310-7, 2007
Koller H et al: 4- and 5-level anterior fusions of the cervical spine: review of literature and clinical results. Eur Spine J. 16(12):2055-71, 2007
Resnick DK et al: Use of ventral plates for cervical arthrodesis. Neurosurgery. 60(1 Supp1 1):S112-7, 2007
Angevine PD et al: Cost-effectiveness of single-level anterior cervical discectomy and fusion for cervical spondylosis. Spine (Phila Pa 1976). 30(17):1989-97, 2005
Rhee JM et al: Indications and techniques for anterior cervical plating. Neurol India. 53(4):433-9, 2005
Moftakhar R et al: Anterior cervical plates: a historical perspective. Neurosurg Focus. 16(1):E8, 2004
Haid RW et al: The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 12(1):E15, 2002
DiAngelo DJ et al: Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine (Phila Pa 1976). 25(7):783-95, 2000
Kirkpatrick JS et al: Reconstruction after multilevel corpectomy in the cervical spine. A sagittal plane biomechanical study. Spine (Phila Pa 1976). 24(12):1186-90; discussion 1191, 1999
Panjabi MM et al: Loosening at the screw-vertebra junction in multilevel anterior cervical plate constructs. Spine (Phila Pa 1976). 24(22):2383-8, 1999
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.