Banked fibula and the locking anterior cervical plate in anterior cervical fusions following cervical discectomy

Scott ShapiroDepartment of Neurological Surgery, Indiana University Medical Center, Indianapolis, Indiana

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✓ Eighty-eight consecutive patients underwent anterior cervical discectomy (ACD) with banked fibula fusion and internal fixation using the locking cervical plate. Pathology included cervical spondylotic radiculopathy in 48, cervical spondylotic radiculomyelopathy in 30, cervical facet dislocations with associated disc herniations in six, and autologous iliac crest graft collapse pseudoarthrosis with recurrent symptoms in four patients. Operations were single-level banked fibula fusion with plating in 37, multilevel banked fibula fusion with plating in 45, and combined single-level ACD banked fibula fusion with plating and posterior fusion in six patients. The only perioperative complication was transient hoarseness. There were no transfusions, infections, neurological injuries, or deaths. The mean time in the hospital for the nontraumatic cases was 1.8 days. The mean follow up was 22 months (range 12–30 months). There has been no motion at the fused level on flexion/extension films, no kyphosis, no screw plate backout, and no banked fibula has suffered graft collapse. Following a high-speed motor vehicle accident 6 months after a multilevel fusion, one alcoholic man suffered a fractured plate with transient worsening of neck pain, and the plate has remained in place for an additional 11 months of follow-up care. Compared to 100 consecutive autologous iliac crest fusions performed by the same surgeon, there were significantly fewer graft-related complications (p < 0.001). There was a significantly greater chance of autologous iliac crest collapsing with the passage of time as compared to banked fibula. Time until return to work was shorter by 5 weeks for the plate/banked fibula group (p < 0.05). When fusion is considered following ACD, the combination of banked fibula and locking cervical plates is significantly superior to autologous iliac crest grafts.

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  • 1.

    Aurori BF, , Weierman RJ, & Lowell HA, et al: Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts. Clin Orthop 199:153158, 1985 Aurori BF, Weierman RJ, Lowell HA, et al: Pseudarthrosis after spinal fusion for scoliosis. A comparison of autogeneic and allogeneic bone grafts. Clin Orthop 199:153–158, 1985

    • Search Google Scholar
    • Export Citation
  • 2.

    Benini A, , Krayenbühl H, & Brüderl R: Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir 61:105110, 1982 Benini A, Krayenbühl H, Brüderl R: Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir 61:105–110, 1982

    • Search Google Scholar
    • Export Citation
  • 3.

    Brown MD, , Malinin TI, & Davis PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:231236, 1976 Brown MD, Malinin TI, Davis PB: A roentgenographic evaluation of frozen allografts versus autografts in anterior cervical spine fusions. Clin Orthop 119:231–236, 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    Buck BE, & Malinin TI: Human bone and tissue allografts. Preparation and safety. Clin Orthop 303:817, 1994 Buck BE, Malinin TI: Human bone and tissue allografts. Preparation and safety. Clin Orthop 303:8–17, 1994

    • Search Google Scholar
    • Export Citation
  • 5.

    Caspar W, & Harkey HL: Anterior cervical fusion. Caspar osteosynthetic stabilization, in Young PH (ed): Microsurgery of the Cervical Spine. New York: Raven Press, 1991, pp 109142 Caspar W, Harkey HL: Anterior cervical fusion. Caspar osteosynthetic stabilization, in Young PH (ed): Microsurgery of the Cervical Spine. New York: Raven Press, 1991, pp 109–142

    • Search Google Scholar
    • Export Citation
  • 6.

    Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:602617, 1958 Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:602–617, 1958

    • Search Google Scholar
    • Export Citation
  • 7.

    Cuatico W: Anterior cervical discectomy without interbody fusion. An analysis of 81 cases. Acta Neurochir 57:269274, 1981 Cuatico W: Anterior cervical discectomy without interbody fusion. An analysis of 81 cases. Acta Neurochir 57:269–274, 1981

    • Search Google Scholar
    • Export Citation
  • 8.

    Espersen O, , Buhl M, & Eriksen EF, et al: Treatment of cervical disc disease using Cloward's technique. I. General results, effect of different operative methods and complications in 1,106 patients. Acta Neurochir 70:97114, 1984 Espersen O, Buhl M, Eriksen EF, et al: Treatment of cervical disc disease using Cloward's technique. I. General results, effect of different operative methods and complications in 1,106 patients. Acta Neurochir 70:97–114, 1984

    • Search Google Scholar
    • Export Citation
  • 9.

    Geisler FH, , Dorsey FC, & Coleman WP: Recovery of motor function after spinal-cord injury—a randomized placebo-controlled trial with GM-1 ganglioside. N Engl J Med 324:18291838, 1991 Geisler FH, Dorsey FC, Coleman WP: Recovery of motor function after spinal-cord injury—a randomized placebo-controlled trial with GM-1 ganglioside. N Engl J Med 324:1829–1838, 1991

    • Search Google Scholar
    • Export Citation
  • 10.

    Goldberg VM, & Lance EM: Revascularization and accretion in transplantation. Quantitative studies of the role of the allograft barrier. J Bone Joint Surg (Am) 54:807816, 1972 Goldberg VM, Lance EM: Revascularization and accretion in transplantation. Quantitative studies of the role of the allograft barrier. J Bone Joint Surg (Am) 54:807–816, 1972

    • Search Google Scholar
    • Export Citation
  • 11.

    Gore DR, , Sepic SB, & Gardner GM, et al: Neck pain: a long-term follow-up of 205 patients. Spine 12:15, 1987 Gore DR, Sepic SB, Gardner GM, et al: Neck pain: a long-term follow-up of 205 patients. Spine 12:1–5, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Hanley EN, , Harvell JC Jr, & Shapiro DE, et al: Use of allograft bone in cervical spine surgery. Semin Spine Surg 1:262270, 1989 Hanley EN, Harvell JC Jr, Shapiro DE, et al: Use of allograft bone in cervical spine surgery. Semin Spine Surg 1:262–270, 1989

    • Search Google Scholar
    • Export Citation
  • 13.

    Harkey HL: Synthes cervical spine locking plate (mosher plate). Neurosurgery 32:682683, 1993 Harkey HL: Synthes cervical spine locking plate (mosher plate). Neurosurgery 32:682–683, 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Lunsford LD, , Bissonette DJ, & Jannetta PJ, et al: Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:111, 1980 Lunsford LD, Bissonette DJ, Jannetta PJ, et al: Anterior surgery for cervical disc disease. Part 1: Treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1–11, 1980

    • Search Google Scholar
    • Export Citation
  • 15.

    Maiman DJ, & Yoganandan N: Biomechanics of cervical spine trauma. Clin Neurosurg 37:543570, 1990 Maiman DJ, Yoganandan N: Biomechanics of cervical spine trauma. Clin Neurosurg 37:543–570, 1990

    • Search Google Scholar
    • Export Citation
  • 16.

    Morscher E, , Sutter F, & Jenny H, et al: Die vordere Verplattung der Halswirbelsäule mit dem Hohlschrauben-Plattensystem aus Titanium. Chirurgie 57:702707, 1986 Morscher E, Sutter F, Jenny H, et al: Die vordere Verplattung der Halswirbelsäule mit dem Hohlschrauben-Plattensystem aus Titanium. Chirurgie 57:702–707, 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Murphy M, & Gado M: Anterior cervical discectomy without interbody bone graft. J Neurosurg 37:7174, 1972 Murphy M, Gado M: Anterior cervical discectomy without interbody bone graft. J Neurosurg 37:71–74, 1972

    • Search Google Scholar
    • Export Citation
  • 18.

    Rosenørn J, , Hansen EB, & Rosenørn MA: Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59:252255, 1983 Rosenørn J, Hansen EB, Rosenørn MA: Anterior cervical discectomy with and without fusion. A prospective study. J Neurosurg 59:252–255, 1983

    • Search Google Scholar
    • Export Citation
  • 19.

    Simmons EH, , Bhalla SK, & Butt WP: Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. Discography: technique and interpretation of results. J Bone Joint Surg (Br) 51:225237, 1969 Simmons EH, Bhalla SK, Butt WP: Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up. Discography: technique and interpretation of results. J Bone Joint Surg (Br) 51:225–237, 1969

    • Search Google Scholar
    • Export Citation
  • 20.

    Smith GW, & Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 40:607624, 1958 Smith GW, Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 40:607–624, 1958

    • Search Google Scholar
    • Export Citation
  • 21.

    Suh PB, , Kostuik JP, & Esses SI: Anterior cervical plate fixation with the titanium hollow screw plate system. A preliminary report. Spine 15:10791081, 1990 Suh PB, Kostuik JP, Esses SI: Anterior cervical plate fixation with the titanium hollow screw plate system. A preliminary report. Spine 15:1079–1081, 1990

    • Search Google Scholar
    • Export Citation
  • 22.

    Zdeblick TA, , Cooke ME, & Wilson D, et al: Anterior cervical discectomy, fusion, and plating. A comparative animal study. Spine 18:19741983, 1993 Zdeblick TA, Cooke ME, Wilson D, et al: Anterior cervical discectomy, fusion, and plating. A comparative animal study. Spine 18:1974–1983, 1993

    • Search Google Scholar
    • Export Citation

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