Anterior cervical plate

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Anterior cervical plates are used in anterior cervical discectomy and fusion (ACDF) surgery to stabilize the cervical spine after the removal of a damaged disc and the insertion of a fusion graft. The classification of anterior cervical plates can be based on various factors, including their design, the number of fixation points, and their intended use. Here’s an overview of the common classifications and types:

### Classification by Design and Function:

1. Fixed-Angle Plates:

1. Description: These plates have screws that lock into the plate at a fixed angle. They provide rigid fixation and are used to ensure stable alignment of the vertebrae.
2. Examples: Locking plates, where screws are fixed into threaded holes in the plate, ensuring a fixed angle and providing strong stability.

2. Dynamic Plates:

1. Description: These plates allow some degree of micromotion at the fusion site, which can be beneficial for certain types of spinal fusions.
2. Examples: Plates with slots or holes that permit controlled movement and compression to stimulate bone growth.

3. Zero-Profile Plates:

1. Description: Designed to be less bulky and to minimize the profile of the implant. These plates are often used in cases where minimizing the risk of dysphagia (difficulty swallowing) is important.
2. Examples: Zero-profile anterior cervical plates are often used in minimally invasive procedures.

### Classification by Number of Fixation Points:

1. Single-Level Plates:

1. Description: Plates designed for use at a single cervical level, typically used in single-level ACDF procedures.
2. Examples: Plates with two fixation points, one for each adjacent vertebra.

2. Multi-Level Plates:

1. Description: Plates that span multiple cervical levels, providing stability for more extensive fusions.
2. Examples: Plates with multiple fixation points, used in multi-level ACDF procedures.

### Classification by Plate Material and Design Features:

1. Titanium Plates:

1. Description: Made from titanium, which is known for its strength and biocompatibility. Titanium plates are commonly used due to their durability and ability to integrate well with bone.
2. Features: Typically lightweight, corrosion-resistant, and often used with titanium screws.

2. Polyetheretherketone (PEEK) Plates:

1. Description: Made from a biocompatible polymer, PEEK plates are radiolucent, meaning they do not interfere with imaging, allowing for better visualization of the fusion.
2. Features: These plates are designed to match the mechanical properties of bone and are used in cases where visualization of the fusion site is important.

### Classification by Plate Shape and Fixation Mechanism:

1. Standard Plates:

1. Description: Plates with a simple, flat design that provides straightforward fixation. Often used in routine ACDF procedures.
2. Features: Typically have multiple screw holes and a simple contour.

2. Contoured Plates:

1. Description: Plates designed with specific contours to match the natural curvature of the cervical spine, providing a more anatomically fitting solution.
2. Features: Often used in cases where the natural curvature of the cervical spine needs to be maintained.

3. Custom Plates:

1. Description: Plates that are custom-designed to fit the specific anatomy of a patient, often used in complex or unusual cases.
2. Features: Tailored to the individual patient’s anatomy and specific surgical needs.

### Key Considerations for Plate Selection:

- Fusion Site Stability: The type of plate used can impact the stability and success of the fusion. - Patient Anatomy: Plates need to be selected based on the specific anatomy and alignment of the cervical spine. - Surgical Goals: The choice of plate depends on whether the goal is to achieve rigid fixation, allow for some movement, or minimize profile.

Overall, the classification and choice of anterior cervical plates are based on the specific needs of the patient, the nature of the spinal pathology, and the goals of the surgical procedure.

A small plate can be applied to the front of the spine. This relatively simple procedure can add considerable stability to the spinal construct.

Anterior plates were developed in the 1980s, and their use was initially restricted to long fusions (multi-level fusions). Now more surgeons are also using them for single level procedures.

The addition of an anterior cervical plate during surgery to protect the bone graft and add extra stability to the spine does not add that much to a cervical fusion procedure. The plates are expensive but help provide for earlier return to normal functioning after surgery. It has become much more commonplace for surgeons to use a plate as a routine addition to a cervical fusion.

Anterior cervical plates for single-level ACDF remains controversial, whereas plating has been shown to improve the results of multilevel ACDF. Plating may provide a useful salvage option for a cervical nonunion, especially if deformity or neurologic compression dictates an anterior approach. Hardware failures may occur with anterior cervical plating, but most remain asymptomatic and do not require operative intervention ¹⁾.

Anterior stabilization with combined plate and bone fusion was performed after neural decompression on ten patients for spondylotic cervical myelopathy, and for radiculopathy or trauma in three patients. Medial corpectomy was performed at one to four levels. Iliac crest or fibular bone grafts were secured by plates anchored to the graft and adjacent vertebral bodies. All patients were placed in Minerva braces postoperatively. There was successful fusion in all cases, and no graft dislodgement or kyphosis. Early initiation of rehabilitation was achieved. Morbidity occurred in patients with severe spondylotic cervical myelopathy. This include respiratory depression requiring reintubation in 2/13 procedures, dysphagia (2/13) from loosening of the screws or prominent hardware and graft, and screw loosening (2/13). Neurological improvement was present in 85% (11/13) of patients. There was no deterioration of neurological function in any case. We conclude from this early follow-up that anterior bone fusion with supplemental plates provides effective stabilization for the unstable cervical spine. Greater morbidity risk exists in patients with severe spondylotic cervical myelopathy and spastic quadriparesis who required multilevel medial corpectomies and fusion ²⁾.

ABC2 anterior cervical plating.

ZERO P® Spacer is a stand-alone anterior cervical interbody fusion device designed to combine the functionality and benefits of a cervical interbody spacer and an anterior cervical plate.

Esophageal perforation incidence may be higher with the use of anterior cervical plate.

The Zero-profile cervical cage was primarily developed aiming to reduce the morbidity associated with the traditional anterior cervical plate. During the past decade, many authors have reported the use of Zero-P spacers for anterior cervical discectomy and fusion (ACDF) of one or two segments ³⁾.