Posterior cervical arthrodesis with AO reconstruction plates and bone graft

The efficacy of posterior arthrodesis of the cervical spine with AO reconstruction plates and autogenous bone graft was evaluated in a prospective study. The technique of surgical exposure and the application of the reconstruction plates fixed with screws to the lateral masses is described in detail. Of 30 patients with unstable cervical spines, all had solid fusions based on flexion and extension radiographs at follow-up averaging 17.8 months. No patient's neurologic function deteriorated. All incomplete spinal cord injuries improved at least one Frankel level. There were no neurologic or vascular complications. At follow-up, three patients had fusions extending one level longer than those instrumented. Three other patients had an increase in kyphosis compared with the operative reduction, which was not clinically significant. Although a single screw loosened in three other patients, none had an increased deformity, and all progressed to successful arthrodesis. This technique is particularly advantageous when spinous processes, laminas, and facets are injured or deficient, or when facet-type fusions are indicated.