Fixed vs dynamic plate complications following multilevel anterior cervical corpectomy and fusion with posterior stabilization

Study design: Comparison of fixed vs dynamic plate complications in cervical surgery. Setting: New York, USA. Methods: Anterior cervical plate-related complications were evaluated following 66 anterior cervical corpectomy and fusion (ACF) with posterior stabilization (PWF) procedures performed in patients with ossification of the posterior longitudinal ligament (OPLL). Clinical data were comparable for both patient populations. Patients averaged between 52 and 53 years of age. The male to female ratio was approximately 2: 1. Surgery addressed MR and CT documented multilevel OPLL in all patients accompanied by spondylosis and stenosis. Preoperatively average Nurick Grades ranged from 3.6 to 3.7. Anterior cervical corpectomies included an average of 2.6 - 3.0 vertebral bodies, while PWF covered seven levels. Fixed plates were applied in the initial 38 patients, while the latter 28 patients had dynamic plates (ABC, Aesculap, Tuttlingen, Germany) applied. Halo devices were used until fusion was documented on both Xray and 2D-CT studies. Patients were followed-up for an average of 5.4 years in the fixed-plated groups, and 2.7 years in the dynamic-plated population. Results: CT and dynamic X-ray confirmed that fusion occurred an average of 4.5 - 4.9 months postoperatively. Five (13%) fixed plates (Medtronic, Sofamor Danek, Memphis, TN, USA) failed warranting secondary surgery, while only one (3.6%) dynamic-plated patient developed a pseudarthrosis and required secondary posterior fusion. Discussion/ Conclusion: Higher failure rates follow multilevel ACF as compared with anterior diskectomy and fusion required to resect multilevel OPLL. Vaccaro et al observed a 9% failure rate following two-level ACFs and 50% failure rate following three-level ACFs performed with fixed plates. In this series, the plate extrusion rate was reduced to 3.6% when dynamic plates were applied.