Bone grafting, implants, and plating options for anterior cervical fusions

The basic principles of cervical spine surgery continue to include adequate decompression, provision of a structurally competent, biologically functional bone graft, and creation of a stable construct to allow for solid fusion. In recent years, the options to achieve these goals have expanded significantly. Bone banking and bone graft substitutes yield increasingly viable alternatives to autogenous bone graft. New prosthetic implants and cages are currently under investigation. The science of bone growth factors seems to be promising and is expected to revolutionize the approach to spinal arthrodesis. Various plating systems are available to provide internal stability to cervical spine constructs. It is important to understand the biomechanics of plating systems so that the optimal system may be used in a given situation. Long constructs place significant loads on SGs and anterior plates. It is important to consider the use of additional fixation, such as posterior segmental fixation in long constructs, which may be prone to failure using only anterior plate fixation. Anterior cervical plating 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.