Abstract
Background: It remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for unstable fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with different plate systems. Patients and Methods: Patients, treated with anterior cervical discectomy and fusion (ACDF) between 2001 and 2015, using either a dynamic plate (DP: Mambo™, Ulrich, Germany) or a rigid locking plate (RP: CSLP™, Depuy Synthes, USA), were identified. For radiological evaluation, the sagittal alignment, the sagittal anterior translation and the bony consolidation were evaluated. After at least two years, the patient-reported outcome measures (PROM) were evaluated using the German Short-Form 36 (SF-36), Neck Disability Index (NDI) and the EuroQol in 5 Dimensions (EQ-5D) scores. Results: 33 patients met the inclusion criteria (DP: 13; RP:20). Twenty-six patients suffered from AO Type B or C fractures. Both the sagittal alignment and the sagittal translation could be sufficiently improved in both groups (p ≥ 0.05). No significant loss of reduction could be observed at the follow-up in both groups (p ≥ 0.05). Bony consolidation could be observed in 30 patients (DP: 12/13 (92%); RP: 18/20 (90%); (p ≥ 0.05)). In 20 patients, PROMs could be evaluated (follow-up: 71.2 ± 25.5 months). The whole cohort showed satisfactory PROM results (EQ-5D: 72.0 ± 4.9; SF-36 PCS: 41.9 ± 16.2, MCS: 45.4 ± 14.9; NDI: 11.0 ± 9.1). without significant differences between the DP and RP group (p ≥ 0.05) Conclusion: The dynamic plate concept provides enough stability without a difference in fusion rates in comparison to rigid locking plates in a population that mostly suffered fragile fractures.
Highlights
In degenerative spine surgery as well as in trauma surgery, anterior cervical discectomy and fusion (ACDF), combining a cage or bone-graft with an anterior plate, is an established treatment of various cervical pathologies [1,2]
Few meta-analyses have evaluated the benefits of dynamic plate systems compared to static systems; most of the clinical studies were conducted for degenerative indications [7,8]
The current study aims to analyze the radiological and mid-term patient-reported outcome measures after ACDF of cervical disco-ligamentous injuries and cervical spine fractures, comparing a dynamic plate system (MamboTM, Ulrich Medical) and a rigid plate system (CSLPTM, Depuy Synthes) in a cohort of 33 trauma patients
Summary
In degenerative spine surgery as well as in trauma surgery, anterior cervical discectomy and fusion (ACDF), combining a cage or bone-graft with an anterior plate, is an established treatment of various cervical pathologies [1,2]. In contrast to degenerative pathologies, traumatic pathologies of the cervical spine inherit remarkable instability, especially when the posterior spinal elements are injured [11]. For this reason, it is questionable if a dynamic plate system provides adequate stability to ensure stable fracture reduction and consolidation over time. It is questionable if a dynamic plate system provides adequate stability to ensure stable fracture reduction and consolidation over time It remains questionable if the treatment of cervical fractures with dynamic plates in trauma surgery provides adequate stability for unstable fractures with disco-ligamentous injuries. The primary goal of this study was to assess the radiological and mid-term patient-reported outcome of traumatic subaxial cervical fractures treated with different plate systems.
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