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Anterior Cervical Plating
Jeffrey S. Ross, MD
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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

          1. Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
          2. 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
          3. Cagli S et al: Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg. 19(4):437-40, 2009
          4. 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
          5. Fountas KN et al: Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 32(21):2310-7, 2007
          6. 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
          7. Resnick DK et al: Use of ventral plates for cervical arthrodesis. Neurosurgery. 60(1 Supp1 1):S112-7, 2007
          8. 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
          9. Rhee JM et al: Indications and techniques for anterior cervical plating. Neurol India. 53(4):433-9, 2005
          10. Moftakhar R et al: Anterior cervical plates: a historical perspective. Neurosurg Focus. 16(1):E8, 2004
          11. Haid RW et al: The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 12(1):E15, 2002
          12. DiAngelo DJ et al: Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine (Phila Pa 1976). 25(7):783-95, 2000
          13. 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
          14. 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
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          Related Differential Diagnoses
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          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

                  1. Jacobs W et al: Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. (1):CD004958, 2011
                  2. 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
                  3. Cagli S et al: Cervical screw missing secondary to delayed esophageal fistula: case report. Turk Neurosurg. 19(4):437-40, 2009
                  4. 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
                  5. Fountas KN et al: Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976). 32(21):2310-7, 2007
                  6. 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
                  7. Resnick DK et al: Use of ventral plates for cervical arthrodesis. Neurosurgery. 60(1 Supp1 1):S112-7, 2007
                  8. 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
                  9. Rhee JM et al: Indications and techniques for anterior cervical plating. Neurol India. 53(4):433-9, 2005
                  10. Moftakhar R et al: Anterior cervical plates: a historical perspective. Neurosurg Focus. 16(1):E8, 2004
                  11. Haid RW et al: The Cervical Spine Study Group anterior cervical plate nomenclature. Neurosurg Focus. 12(1):E15, 2002
                  12. DiAngelo DJ et al: Anterior cervical plating reverses load transfer through multilevel strut-grafts. Spine (Phila Pa 1976). 25(7):783-95, 2000
                  13. 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
                  14. 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