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To stabilize anterior cervical fusions, anterior cervical plating is routinely used. Dynamic plates, with screws that may either toggle inside fixed holes or translate within slotted holes, are among the modern plating alternatives.
Whatever plating system is used, meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft, are critical to success and avoiding complications with plated anterior cervical fusions.
To avoid graft-related complications associated with long-strut grafts, additional posterior fixation and fusion or alternative corpectomy constructs such as multilevel anterior cervical discectomy and fusion, corpectomy-discectomy, and corpectomy-corpectomy should be considered if the stenosis pattern allows.
As an adjuvant to anterior cervical discectomy and fusion (ACDF), anterior cervical plating offers various potential advantages.
It promotes greater fusion rates, allowing for less burdensome external immobilization, and minimizes the frequency of graft extrusion.
However, anterior plating has certain drawbacks: it increases surgical time and cost, and it makes revision anterior surgery more difficult if the plate needs to be removed.
Furthermore, there are a number of potential implant-related complications that can occur with plating, including esophageal erosion from loose plates and screws, adjacent level or peri-plate ossification from plates that abut adjacent disc spaces, and errant screws that can injure adjacent discs, nerve roots, and other structures.
Detail is not paid during surgical planning and intraoperatively. Plating should not necessarily be relied upon to compensate for poor graft carpentry, nor can it reliably produce clinical success in the face of biomechanically unsound constructs or those in which appropriate consideration has not been given to biologic factors such as graft type vis-a-vis host healing potential.
In this article, review considerations in performing anterior cervical plating, and discuss technical and biomechanical factors associated with successful use.
There is no clear consensus on its indications since its introduction by Bohler. Plates are often employed in the treatment of cervical spine degenerative conditions, tumors, trauma, and deformity.
Although the reason for anterior plate fixation in reconstructing unstable disorders such as tumors or fractures appears evident, it is questionable if anterior plating is genuinely beneficial in many common cervical spine spondylotic diseases.
Several studies have failed to show a difference in union rates for single-level plated autograft ACDF, despite the fact that plating may allow for reduced graft collapse and segmental kyphosis as the graft heals.In contrast, the research generally suggests that plating of multilayer ACDFs (i.e., two or more segments) results in greater fusion rates.
The research also shows that plating ACDFs at one or more layers accomplished with allograft alone may be beneficial.
In addition to ACDFs, anterior plates are routinely employed to stabilize corpectomy structures. In most cases, a one- or two-level plated corpectomy yields satisfactory results.
However, failure rates for three or more level plating corpectomies have been found to be exceedingly high. Although it may appear logical to believe that an anterior cervical plate would reduce the incidence of graft-related complications in multilevel strut graft reconstructions, clinical series of plated multilevel corpectomies have been associated with higher graft complication rates than unplated counterparts.
Despite anterior plating, graft displacement rates were lower in a two-level corpectomy than in a three-level corpectomy in one research.
In vitro, multilevel plated corpectomies have also been shown to reverse load transfer via the strut graft, resulting in the graft being paradoxically unloaded in flexion and loaded to supraphysiologic levels in extension.
These findings show that plating cannot compensate for an overwhelming biomechanical environment. Instead of performing a multilevel plated corpectomy with a single, long-strut graft in patients with multilevel stenosis, posterior approaches such as laminoplasty, combined anterior decompression with posterior fixation, or, if anterior only surgery is preferred, the use of alternative corpectomy constructs as described below should be considered.
If an anterior-only method is chosen for the patient with multiple segment stenosis, cervical plating can still be done.
The Global Anterior Cervical Plate System Market accounted for $XX Billion in 2022 and is anticipated to reach $XX Billion by 2030, registering a CAGR of XX% from 2024 to 2030.
Nvision Biomedical Technologies and Watershed Idea Foundry have won FDA approval for what is said to be the world’s first 3D printed titanium anterior cervical plate.
The medical device, known as the Quantum Titanium Cervical Plate System, is a tiny plate that is widely used to offer spine stabilization following surgery.
Nvision and Watershed were able to harness the design benefits of additive manufacturing by 3D printing their cervical plate, integrating numerous smaller components into one monolithic element.
According to the companies, this considerably minimizes the chance of a patient disassembly of a device. When compared to a conventionally made counterpart, the 3D printed Quantum Titanium Cervical Plate System has reduced manufacturing costs and shorter lead times.
Nvision Biomedical Technologies is a biomedical technology company.Anterior cervical plates, which were developed , are put to the front of the spine after surgery to preserve bone grafts and provide stability to the spinal construct as it heals.
They were originally utilized in lengthy cervical fusions, but are now being employed for anterior cervical decompression, fusion for cervical spondylosis, degenerative disc disease, and scoliosis.
Cervical plates are often highly expensive to build and include multiple tiny components, which means they may dismantle themselves if not fitted or screwed in correctly. This is what the Quantum Titanium Cervical Plate System is all about.
