Stress-shielding compared with load-sharing anterior cervical plate fixation : a clinical and radiographic prospective analysis of 50 patients

In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained i...

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Bibliographic Details
Published in:	Journal of neurosurgery. Spine Vol. 6; no. 5; pp. 391 - 397
Main Authors:	SAPHIER, Paul S, ARGINTEANU, Marc S, MOORE, Frank M, STEINBERGER, Alfred A, CAMINS, Martin B
Format:	Journal Article
Language:	English
Published:	Charlottesville, VA American Association of Neurological Surgeons 01-05-2007
Subjects:	Adult Aged Biological and medical sciences Bone Plates Cervical Vertebrae - diagnostic imaging Cervical Vertebrae - surgery Chi-Square Distribution Decompression, Surgical Diskectomy - instrumentation Female Humans Ilium - transplantation Male Medical sciences Middle Aged Neurosurgery Orthopedic surgery Prospective Studies Radiography Regression Analysis Spinal Fusion - instrumentation Spinal Osteophytosis - surgery Stress, Mechanical Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Human load sharing Instrumentation anterior cervical discectomy and fusion anterior cervical plate fixation spinal instrumentation stress shielding Stress Radiography Fixation Exeresis Discectomy Intervertebral disk
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Summary:	In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained in the two cohorts were analyzed to determine whether clinical or radiographic differences would emerge. All patients underwent either one- or two-level fusion in which freeze-dried allogenic tricortical iliac crest bone graft was used. In the first cohort of 25 patients entered into the study, fixation was achieved using a stress-shielding anterior cervical plate (ACP) system, whereas in the second cohort of 25 patients a load-sharing plate system was employed. Patients were evaluated during a follow-up period that ranged from 12 to 35 months. Outcome was determined using a standard questionnaire by which the authors gauged the level of pain, disability, and satisfaction following surgery. The success of surgical fusion and the magnitude of the translation were determined by radiographic evaluation. There was no statistically significant difference between the two cohorts with respect to age, sex, smoking rate, and postoperative complications. With regard to pain and functionality, there was a significant difference (p < 0.05) in favor of the load-sharing system. The fusion rates with the load-sharing and stress-shielding systems were 96 and 92%, respectively, and this difference was not significant. There was no significant difference between the two cohorts with regard to overall satisfaction. The magnitude of vertical translation was significantly greater in the stress-shielding ACP group (p < 0.05) for treatment at one level but not at two. Clinical and radiographic data were available in all patients. Load-sharing ACP systems exhibited superior clinical results compared with stress-shielding ACPs in this series of patients. The symptomatic pseudarthrosis rate was lower in the load-sharing ACP-treated patients, although this was not statistically significant.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1547-5654 1547-5646
DOI:	10.3171/spi.2007.6.5.391