A Comparison of Fixed-hole and Slotted-hole Dynamic Plates for Anterior Cervical Discectomy and Fusion

Abstract

A retrospective review of clinical data at 1 institution was performed. To compare the clinical and radiologic outcomes between fixed-hole and slotted-hole dynamic cervical plates. Anterior cervical plating is commonly used to increase stability and promote spinal fusion. Two techniques, fixed-hole dynamic plating that uses variable angled screws and slotted-hole dynamic plating that permits sliding, are viable options, but there have been no clinical studies comparing their effectiveness. Fifty-six patients at 1 institution having anterior cervical discectomy and fusion for degenerative disease over a 5-year period were entered into this study. Surgeries were performed with 1 of the dynamic plates for 1 to 3 levels. For the slotted-hole dynamic plate group, a slotted-hole plate was used (ABC, Aesculap, Tuttlingen, Germany or C-tek, Biomet, Parssipany, NJ) and for the fixed-hole dynamic plated group, a variable angled screw was used (C-tek, Biomet, Parssipany, NJ). Radiographic measurements included were graft subsidence, lordotic angle change from each end plate of fusion construct, and implant translation from end plates after a minimum of 12 months follow-up. Fusion state and clinical outcome using Odom's criteria were also evaluated. Demographics were not different among patient populations. The average age of the patients was 51.0 years (range: 27 to 77 y). Mean follow-up period was 20.6 months (range: 12 to 41 mo). Slotted-hole dynamic plates were used for 29 patients (ABC plate, 17; C-tek plate, 12) and fixed-hole dynamic plates for 27 patients. Clinical outcomes and pseudoarthrosis rates were similar for both types of plates. Radiographic measurements showed a statistically significant increased incidence of graft subsidence and implant translation with the slotted-hole dynamic plates. Loss of lordosis was also greater in the slotted-hole dynamic plated group, although the difference was not statistically significant. The use of a fixed-hole dynamic plate is more favorable in regards to graft subsidence and implant translation in the follow-up period, although clinical outcome and fusion rates are similar in patients with either the fixed-hole or slotted-hole dynamic plates.