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A new anterior cervical instrumentation system combining an intradiscal cage with an integrated plate: an early
G Samandouras1, M Shafafy, P J Hamlyn
1Department of Neurosurgery, Royal London Hospital, Saint Bartholomew's and the Royal London School of Medicine, London, United Kingdom.
Study Design:
To provide a technical report on a new device. Early outcome assessment of patients undergoing anterior cervical decompression and stabilization with the described technique.
Objectives:
To detail the operative and technical aspects of the new anterior cervical instrumentation and to identify its suitability for an extensive clinical study.
Summary Of Background Data:
The controversy over the need for fusion in the surgery of cervical disc disease is in part fueled by the absence of an ideal technique. However, the design of the integrated anterior cervical plate and cage device (PCB) appears to provide immediate stability and to restore disc height and cervical lordosis in addition to reducing graft recipient and donor site-related complications.
Methods:
After a standard anterior cervical discectomy and preparation of the disc space, the correct size of the cage with integrated plate is inserted. Self-tapping screws are inserted without image intensifier. Cancellous bone chips are used. The technique was used in 29 patients that were followed prospectively from 5 to 24 months (median 8 months, interquartile range 6-15 months).
Results:
The technique was easy to learn and implement. The authors' experience has been free of intraoperative complications. After surgery no screw backout or device failure was identified. Twenty-seven patients improved clinically. Donor site morbidity was trivial. No collars were applied after surgery.
Conclusions:
The design of the system appears to prevent bone-graft recipient site and donor site complications, provides immediate biomechanical stability, prevents screw backout or breakage, and restores posterior interbody height and lordosis. The device is of sufficient promise to warrant further close evaluation focusing on long-term outcome. The new radiolucent version has potential advantages for the assessment of fusion.