Anterior Cervical Fusion Using Caspar Plating: Analysis of Results and Review of the Literature

doi:10.1016/S0090-3019(97)00306-6

Surgical Neurology

Volume 49, Issue 1, January 1998, Pages 25-31

https://doi.org/10.1016/S0090-3019(97)00306-6 Get rights and content

Abstract

Background

Ninety-seven patients underwent anterior cervical fusions after discectomy and/or corpectomy. Fibular allograft was used in 13 cases and iliac crest was used in the remaining 84 patients.

Methods

Lateral cervical spine X-rays were reviewed for evaluation of fusion and instrumentation failures.

Results

Solid fusion was achieved in all but two patients (97.91%). Nineteen patients developed instrumentation related failures. Seven patients developed fracture of one screw each (one superior and six inferior). Ten patients developed screw back out (inferior screw) and in one patient the superior screws were found to be 2 mm posterior to the posterior cortex but did not cause any neurological deficits. Seven of these patients underwent revision surgery. No complications related to the instrumentation were encountered in the last 34 cases. There were no infections in this series. Five patients developed temporary dysphagia. Two developed temporary deltoid weakness and three patients developed transient recurrent laryngeal nerve palsy. One developed acute airway obstruction but the patient had a pre-existing epiglottic anomaly and sleep apnea disorder.

Conclusions

In selected cases, the Caspar plating system affords an effective means of improving the fusion rate (97.91%) with acceptable instrumentation-related morbidity that improves with experience, (10.7% in the first 38 cases and 1.69% in the last 59 with an overall rate of 7.2%). Temporary neurological deficits seen in this series were probably not related to the Caspar plating procedure itself. Intraoperative fluoroscopic films can be misleading. Therefore regular lateral cervical spine X-rays postplating in the operating room prior to closure are recommended. Lower screws backed out in all failures and this was circumvented by using the bigger (rescue) screws at the inferior end of long constructs.

Section snippets

Methods

Ninety-seven patients who underwent anterior cervical spine surgery with Caspar plating between July 1990 and December 1995 were included in this study. The average follow-up for these patients was 9 months. The ages of the patients ranged from 17 to 80 with a mean of 50.32 (± SD 12.83). Forty-four of the patients were male and fifty-three were female. The average hospital stay for the patients was approximately 3 days for patients with degenerative spinal conditions and longer for patients

Results

Ninety-seven patients underwent anterior cervical fusions following discectomies and/or corpectomies. Fibular allograft was used in 13 cases and iliac crest graft was used in the remaining 84 patients. Six patients had four levels fused; 52 had three levels fused; 27 had two levels fused; and 12 had only one level fused. Nineteen patients developed instrumentation failure. Seven patients developed fracture of one screw each, one superior (Fig. 1A, B) and six inferior screws (Fig. 2A, B). Ten

Discussion

Orozcor and Llovet first approved the use of anterior cervical plate stabilization for fixation of the traumatically unstable spine in 1970 [18]. Subsequently Caspar described his experiences using the trapezial osteosynthetic plate developed by him for anterior stabilization of the cervical spine 5, 6. Anterior cervical fusion for disc disease as well as trauma was first popularized by Cloward, Smith, and Robinson 7, 8, 24. However, in the presence of ligamentous instability this method does

Acknowledgements

I would like to acknowledge the assistance of Dorothy Bose, R.N., B.S.N.; Marykay Ennis; and Michelle Bellon, who helped with the preparation of the manuscript.

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Two comparable subgroups of 29 patients each were recruited for the present investigation. The first cohort was composed of ACDF patients, whereas the second cohort was composed by healthy subjects. Inclinometry/Range of Motion (RoM) analyses of the neck, and cervical muscles electromyography (EMG) were used to evaluate the neck mobility. We investigated the effects of physiotherapy on ROM and EMG results in order to identify possible significant differences between healthy subjects and ACDF patients.
A total of 58 patients were included in the final cohort. Extensive statistical analysis disclosed that higher NDI values were associated with a reduction of the Extension and Rotation movements, NDI scores, were found to be negatively associated to EMG voltages for Rotation, independently of the physiotherapy performed either. Extension, Lateral Bending, and Rotation showed significant improvement after just one session of physiotherapy, whereas Flexion and Extension proved to be those that contributed most to the overall neck mobility.
The cervical spine fusion contributes to an overall reduction of cervical mobility. This data is confirmed by inclinometer and EMG parameters. Physiotherapy increases neck mobility thus possibly improving the clinical status of patients.
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Anterior cervical spine surgery (ACSS) was introduced and described by Smith and Robinson1-3 >50 years ago and since then has been refined, especially with the addition of anterior plate positioning and screw stabilization.4-6
Pharyngoesophageal injury during anterior cervical spine surgery is a rare and potentially life-threatening complication; generally it is the result of intraoperative manipulation or hardware erosion and sometimes may be due to weakness of the pharyngoesophageal wall from pre-existing pathologic conditions, such as diabetes, gastritis, or obesity.
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Appropriate treatment for pharyngoesophageal perforations is controversial and not investigated in detail. There is a lack of prospective studies comparing initial conservative versus surgical approaches to treatment. In addition, endoscopic management is growing as a therapeutic option, but no consensus concerning the indications for an endoscopic approach in the treatment of pharyngoesophageal injury in anterior cervical spine surgery is currently reached. A common theme proposed in the literature is that early recognition and aggressive investigation and treatment are essential to ensure a good outcome. A customized interdisciplinary surgical approach is essential for successful treatment. Use of the transoral endoscopic approach is a useful noninvasive method to treat this rare but potentially devastating complication.
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The clinical outcomes, radiological parameters, complication rate and the cost of implants in two-level ACDF with and without screws in the intervening segment were compared.
A retrospective study of 68 patients who underwent 2-level ACDF from January 2014 to June 2016 was performed. The patients were divided into two groups: ACDF with screws in the intervening vertebra and those without screws in the intervening vertebra. Perioperative factors, clinical outcomes, postoperative complications, radiological parameters, and cost of the implants were evaluated in both groups.
No statistical differences in clinical outcomes, operative blood loss, hospital stay, restoration of cervical lordosis or segment height, postoperative complications, and fusion rate were found between the ACDF (middle vertebra with screw) and ACDF (middle vertebra without screw) groups (P > 0.05). But the operative time of added screw placement and cost of implants in the ACDF (middle vertebra without screw) group were significantly less than the ACDF (middle vertebra with screw) group (P < 0.05).
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The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis.
A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography.
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Posterior fixation may reduce micromotion at the graft-host interface, and resist graft settling, but add to costs, risks and operative time [31]. Whilst posterior fixation with pedicle screws or facet screws is commonly employed to stabilize fusions, there have also been reports of associated morbidity, namely instrumentation failure [32]. We believe there is a role for additional posterior fixation in pathologies such as isthmic spondylolisthesis, osteoporosis and multilevel procedures [33,34].
Anterior lumbar interbody fusion (ALIF) is a common procedure for patients with degenerative pathologies of the lumbar spine. In this study, the clinical and radiological outcomes of a combination titanium/polyetheretherketone (Ti/PEEK) ALIF cages in one, two and three-level surgery were evaluated. Over an 18-month time period, a prospective single surgeon series of 20 implants (15 patients) were included in the study, with minimum 10-months follow-up. From these 15 patients, two were supplemented with posterior percutaneous pedicle screw fixation for additional stability. Radiological follow-up with fine cut CT scan at 9–12 months was performed to evaluate early fusion rates, and integration of the Titanium/PEEK cage at the endplate junction. 20 implants were followed for a minimum of 10 months, and a mean of 15 months. A 95% (19/20 implants) fusion rate with no implant related complications was achieved at the mean 15-month postoperative mark. Patients experienced statistically significant improvement in pain and functional outcomes (SF12 and ODI) compared to their pre-operative status. A single patient with a non-union at L5/S1 (smoker) did not experience any improvement in symptoms. A Ti–PEEK cage, with allograft and BMP-2 to achieve interbody fusion is an effective implant for use in anterior lumbar surgery with high fusion rates, no lucency around the titanium endplates at follow-up, and with promising early results.

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Original ArticlesAnterior Cervical Fusion Using Caspar Plating: Analysis of Results and Review of the Literature

Abstract

Section snippets

Methods

Results

Discussion

Acknowledgements

Surg Neurol

Treatment of cervical spine injuries with anterior plating (indications, techniques, and results)

Spine

Stabilization of the cervical spine by anterior fusion

J Bone Joint Surgery (AM)

Internal metal plate fixation combined with anterior interbody fusion in cases of cervical spine injury

Neurosurgery

Osseous Lesions of the Cervical Spine

Clin Neurosurg

Anterior cervical fusion and caspar plate stabilization for cervical trauma

Neurosurgery

Advances in cervical spine surgery. First experiences with the trapezial osteosynthetic plate and a new surgical instrumentation for anterior interbody stabilization

Orthop News

The anterior approach for removal of ruptured cervical disks

J Neurosurg

Treatment of acute fractures and fracture dislocations of the cervical spine by vertebral body fusion

J Neurosurg

Anterior decompression, structural bone grafting, and caspar plate stabilization for unstable cervical spine fractures and/or dislocations

Spine

The anterior cervical plate

Spine

Subtotal cervical body replacement by C-shaped iliac crest graft, technical note

Acta Neurochir (Wien)

Anterior cervical fusion and osteosynthetic stabilization according to Caspara prospective study of 41 patients with fractures and/or dislocations of the cervical spine

Neurosurgery

Original Articles
Anterior Cervical Fusion Using Caspar Plating: Analysis of Results and Review of the Literature