Anterior junctional plate in the cervical spine

Study Design. This study introduces a useful plating techniques for complex reconstructions of the anterior cervical spine. Objective. To provide a short-segment-buttressing technique for the stabilization of long anterior fusion constructs in the cervical spine while avoiding the potential morbidity and risks associated with long-segment anterior cervical plating. Summary of Background Data. Anterior fibular or iliac crest strut grafts are at risk of dislodging when used after multisegment (>3 vertebrae) corpectomy in various spinal disorders. Long-segment anterior cervical plates have been used to reduce the incidence of graft displacement and migration but have been shown to increase risk for early failure because of screw dislodgement. Methods. Eleven patients with cervical myelopathy underwent a multilevel (average 3.36 levels) corpectomy followed by the placement of a fibular or iliac crest strut graft. An anterior short-segment locking or buttress plate was then placed in the vertebral body, either inferior or superior to the seated graft, depending on the ease of insertion or quality of the host bone. Posterior segmental fixation was performed in all patients during the same procedure. The average follow-up was 30.8 months (range 25-36 months). Results. No incidence of plate or graft migration (anteroposterior plane) or dislodgement was reported in this series. One graft fracture occurred secondary to the placement of a intragraft screw through an anterior junctional plate. No patients experienced clinical morbidity related to the junctional plate. Neurovascular complications and wound complications were not encountered in any of these patients. All had an improvement in their neurologic symptoms, and 10 of the 11 patients had fusion documented on plain radiographs. Conclusions. The use of a junctional plate anteriorly along with posterior segmental fixation and fusion may prevent or decrease the incidence of graft and internal fixation dislodgement after a long-segment cervical reconstruction procedure.