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Orthopaedic Surgery Spine
Figure 8: Case 4 – Post-operative Radiograph After Extending Figure 9: Neck Pain
ACDF and Revising the Plate Instrumentation
VAS
10
8
6
4
2
0
Pre-op 7-12 1-2 2-3 3-5 6-8
months years years years years
Follow-up Period
DDD HNP Stenosis
patient, as demonstrated in our patient.
9,10
As in Case 1, a plate was used
to enhance the fusion rate.
Case 4 demonstrates the potential for problems at the adjacent level
above or below an ACDF and some of the challenges in revision surgery,
including revising the plate instrumentation. In the author’s study of
long-term follow-up patients, the rate of extending an ACDF was 8%.
Currently, disc replacement techniques have the theoretical advantage of
large series had fantastic results using a bioresorbable plate (Mystique, reducing adjacent level degeneration.
Medtronic Sofamor Danek, Memphis, Tennessee) and an exceedingly
high fusion rate.
7
Another publication using an identical bioresorbable Our results are consistent with what has been previously published, and
plate and published within a month of the larger series documented a readers are referred to a recent review article.
11
We have analysed our
50% failure rate.
8
These two articles have widely discrepant results. The long-term (six- to eight-year) follow-up of approximately 150 ACDF
author has used this plate in the past, but discontinued for the same patients and categorised them based on primary diagnosis of stenosis,
reasons encountered by the second series above, and now prefers a disc herniation or discogenic pain with predominantly axial symptoms.
more robust bioresorbable plate (Inion Ltd). The author believes the true All diagnostic groups, with approximately 50 patients in each group,
success rate of bioresorbable plates are somewhere in between the showed a significant improvement in all outcome scales over the
results reported by the two studies, and that patient selection is follow-up period and is shown graphically for neck pain (see Figure 9).
important for success. The arm pain scores of patients showed a full two-point (average)
additional improvement post-operatively for all groups. Typically, the
Case 3 is a patient with predominantly axial pain symptoms. There was greatest improvement in outcomes was for those patients with a disc
controversy for performing ACDF for patients with purely discogenic herniation. The patients with purely axial pain due to degenerative disc
pain. However, this is becoming more accepted and there are now disease or discogenic pain also show improvement, but not as great as
studies documenting improved outcomes for the appropriately selected that in the other two diagnostic groups. ■
1. Butterman Gr, Anterial Cervical Discectomy – Outcomes and 5. Wang JC, McDonough PW, Endow K, et al., The effect of failure analysis, J Spinal Disord Tech, 2007;20(3):248–54.
the future, US Musculoskeletal Review, 2006;2:23–4. cervical plating on single-level anterior cervical discectomy and 9. Palit M, Schofferman J, Goldthwaite N, et al., Anterior
2. Wang JC, McDonough PW, Endow KK, Delamarter RB, fusion, J Spinal Disord, 1999;12(6):467–71. discectomy and fusion for the management of neck pain, Spine,
Increased fusion rates with cervical plating for two-level 6. Freeman AL, Derincek A, Beaubien BP, et al., In vitro 1999;24(21):2224–8.
anterior cervical discectomy and fusion, Spine, 2000;25(1): comparison of bioresorbable and titanium anterior cervical 10. Garvey TA, Transfeldt EE, Malcolm JR, Kos P, Outcome of
41–5. plates in the immediate postoperative condition, J Spinal Disord, anterior cervical discectomy and fusion as perceived by patients
3 DuBois CM, Bolt PM, Todd AG, et al., Static versus dynamic 2006;19(8):577–83. treated for dominant axial-mechanical cervical spine pain,
plating for multilevel anterior cervical discectomy and fusion, 7. Aryan HE, Lu DC, Acosta FL Jr, et al., Bioabsorbable anterior Spine, 2002;27(17):1887–95.
Spine J, 2007;7(2):188–93. cervical plating: initial multicenter clinical and radiographic 11. Rao RD, Currier BL, Albert TJ, et al., Degenerative cervical
4. Samartzis D, Shen FH, Lyon C, et al., Does rigid instrumentation experience, Spine, 2007;32(10):1084–8. spondylosis: clinical syndromes, pathogenesis, and
increase the fusion rate in one-level anterior cervical discectomy 8. Brkaric M, Baker KC, Israel R, et al., Early failure of management, J Bone Joint Surg Am, 2007;89(6):1360–78.
and fusion?, Spine J, 2004;4(6):636–43. bioabsorbable anterior cervical fusion plates: case report and
88 EUROPEAN MUSCULOSKELETAL REVIEW 2007
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