Dynamic cervical plate versus static cervical plate in the anterior cervical discectomy and fusion: a systematic review

Abstract

This study performs a systematic review to compare the functional outcomes and complications between the dynamic cervical plate and static cervical plate in patients with the anterior cervical discectomy and fusion (ACDF). The common static cervical plates have been widely used in the ACDF. It can successfully increase the fusion rate and decrease the surgery failure. Recently, the dynamic plate has been identified as another safe and efficient option for the better fusion rate by promoting load sharing across the construct. However, the proposed benefits have been largely theoretical, and there is considerable controversy as to which plate is a better option for reconstruction after ACDF. We searched the Cochrane Library, EMBASE, PubMed, and CBM to identify the clinical studies regarding the comparison of dynamic cervical plate with fixed cervical plate in the ACDF. Reports not available in English were excluded. The quality of the included studies was critically assessed, and the data analysis was performed by the Cochrane Collaboration's RevMan 4.2. We defined statistical significance as a P value <0.05. Five studies were included in this systematic review. In the final analysis, there were 172 patients in the dynamic cervical plate and 143 in the static cervical group. Four studies compared the clinical and radiographic outcomes between the two plate groups in the one-level or two-level fusion segmentation patients, while one studied the patients with the multiple levels. The similar clinical outcomes between the two cervical plate systems were reported in two studies. However, another study suggested that a better clinical outcome was found in the dynamic plate group for the multiple-level fusion patients, although the similar clinical outcome was found in the one-level fusion patients. The two RCT studies with the same clinical data reported that four patients in the static group developed hardware complications, while there was no implant complication in the dynamic group. The clinical outcome was similar in ACDF for one-level fusion patients, although the hardware failure rate was higher in ACDF with static plates.