Risk-benefit ratio of single and multilevel anterior cervical plate stabilization for degenerative disease

Introduction: Graft related complications are highly undesired side effects of anterior cervical fusion operations. They occur in 5-25% of single level fusions with an increase in multisegmental cases. In 1980 Caspar first reported on the advantages of an additional anterior trapezoidal plate stabilization with reduction of pseudarthrosis rates to 2%. Since then, there has been controversy about the use of additional plate stabilization particularly in single level fusions. One argument is that the reduction of pseudarthrosis could well be equaled by plate-inherent complications. Methods: Our retrospective analysis has shown the following results: From 1990 to 1993 116 patients (79 male, 37 female) were evaluated. Average age was 45.7 years, ranging from 23 to 72 years. 71.5% suffered with radiculopathy, 19% myelopathy and 9.5% myeloradiculopathy. 50% underwent fusion, 50% received additional plating. Results: Single level operations were performed in 69.8%, two levels in 24.1%, three levels in 6.1%. The average follow-up period was 6 months (solid fusion accomplished or decision for re-operation). In 8.6% re-do surgery was required (pseudarthrosis 6.7%, removal of a loosened screw (0.86%), plate replacement (0.86%)). The revision rate in cases with single level fusion + plating was 0% compared to 12.6% without plate stabilization. Bisegmental fusion with plating accounted for 3.6% re-operations and three level fusion + plating for 0%. Revisions only for pseudarthrosis were 1.7% versus 12.6%. The total revision rate for plate osteosynthesis (one, two and three levels) was 5.2% versus 12.6% in non plate fusions (Chi-square test with p = 0.01 is highly insignificant). Discussion and Conclusions: Plate stabilization can also be recommended for single and multilevel fusions in degenerative disease and does not constitute an over-treatment but supplements anterior cervical fusion.