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Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus

Dynamic plate. (A) Rotationally dynamic plate (Atlantis Vision, adapted from http://www.medtronic.com/, with permission of Medtronic). (B) Translational plate with slotted screw holes (ABC-2, adapted from http://www.aesculapimplantsystems.com/, with permission of Aesculap AG). (C) Translational plate with plate telescope (Atlantis translational, adapted from http://www.medtronic.com/, with permission of Medtronic).
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Figure 4: Dynamic plate. (A) Rotationally dynamic plate (Atlantis Vision, adapted from http://www.medtronic.com/, with permission of Medtronic). (B) Translational plate with slotted screw holes (ABC-2, adapted from http://www.aesculapimplantsystems.com/, with permission of Aesculap AG). (C) Translational plate with plate telescope (Atlantis translational, adapted from http://www.medtronic.com/, with permission of Medtronic).

Mentions: Anterior cervical plate was developed in early 1980 and it was first developed for use in cervical spinal trauma like fracture or dislocation. With successes in trauma, anterior plate fixation has spread to use in degenerative cervical spinal diseases. There are theoretical benefits with additional fixation with anterior plating such as initial stability, early mobilization and minimizing external bracing, prevention of bone graft callapse or extrusion, improved bone fusion and maintenance of sagittal alignment. Although anterior plating in long cervical fusion (two or more levels) with high pseudoarthrosis rate can be justified [16,23,41], the routine use in single-level fusion is still controversial due to the additional cost and possibility of complications with the use of plate [42,43]. Currently the wide array of anterior cervical fixation devices were developed and available. Cervical Spine Study Group [44] has classified them based to the biomechanical characteristics (Fig. 3). The earlier cervical plates had catastrophic issues such as screw backout and esophagus damage, but with the technical advance in implant design including locking mechanism, the complications have been decreased. Also use of locking screw eliminate the nessecity of bicortical fixation and have decreased the possibility of spinal cord damage. Since then the concept of dynamization was introduced and many dynamic plate designs were developed. Compared to the existing static (constrained) plate, dynamic plate has an advantage of early bone fusion because it prevents the stress shielding and transfer axial loading onto bone graft sufficiently through settling [45]. Also metal failure such as screw loosening or breakage due to nonunion and subsidence of bone graft can be reduced. According to the dynamization method, dynamic plate types are classifies as; rotational plate, translational plate with slotted screw holes, translational plate with plate telescope (Fig. 4).


Current concepts of anterior cervical discectomy and fusion: a review of literature.

Song KJ, Choi BY - Asian Spine J (2014)

Dynamic plate. (A) Rotationally dynamic plate (Atlantis Vision, adapted from http://www.medtronic.com/, with permission of Medtronic). (B) Translational plate with slotted screw holes (ABC-2, adapted from http://www.aesculapimplantsystems.com/, with permission of Aesculap AG). (C) Translational plate with plate telescope (Atlantis translational, adapted from http://www.medtronic.com/, with permission of Medtronic).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150000&req=5

Figure 4: Dynamic plate. (A) Rotationally dynamic plate (Atlantis Vision, adapted from http://www.medtronic.com/, with permission of Medtronic). (B) Translational plate with slotted screw holes (ABC-2, adapted from http://www.aesculapimplantsystems.com/, with permission of Aesculap AG). (C) Translational plate with plate telescope (Atlantis translational, adapted from http://www.medtronic.com/, with permission of Medtronic).
Mentions: Anterior cervical plate was developed in early 1980 and it was first developed for use in cervical spinal trauma like fracture or dislocation. With successes in trauma, anterior plate fixation has spread to use in degenerative cervical spinal diseases. There are theoretical benefits with additional fixation with anterior plating such as initial stability, early mobilization and minimizing external bracing, prevention of bone graft callapse or extrusion, improved bone fusion and maintenance of sagittal alignment. Although anterior plating in long cervical fusion (two or more levels) with high pseudoarthrosis rate can be justified [16,23,41], the routine use in single-level fusion is still controversial due to the additional cost and possibility of complications with the use of plate [42,43]. Currently the wide array of anterior cervical fixation devices were developed and available. Cervical Spine Study Group [44] has classified them based to the biomechanical characteristics (Fig. 3). The earlier cervical plates had catastrophic issues such as screw backout and esophagus damage, but with the technical advance in implant design including locking mechanism, the complications have been decreased. Also use of locking screw eliminate the nessecity of bicortical fixation and have decreased the possibility of spinal cord damage. Since then the concept of dynamization was introduced and many dynamic plate designs were developed. Compared to the existing static (constrained) plate, dynamic plate has an advantage of early bone fusion because it prevents the stress shielding and transfer axial loading onto bone graft sufficiently through settling [45]. Also metal failure such as screw loosening or breakage due to nonunion and subsidence of bone graft can be reduced. According to the dynamization method, dynamic plate types are classifies as; rotational plate, translational plate with slotted screw holes, translational plate with plate telescope (Fig. 4).

Bottom Line: Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported.To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established.Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedic Surgery, Chonbuk National University Hospital, Research Institute of Clinical Medicine, Biomedical Science Institute, Chonbuk National University Medical School, Jeonju, Korea.

ABSTRACT
Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure for degenerative cervical spinal disease unresponsive to conservative management and its outstanding results have been reported. To increase fusion rates and decrease complications, numerous graft materials, cage, anterior plating and total disc replacement have been developed, and better results were reported from those, but still there are areas that have not been established. Therefore, we are going to analyze the treatment outcome with the various procedure through the literature review and determine the efficacy of ACDF.

No MeSH data available.


Related in: MedlinePlus