Posterior Lateral Mass Plate Fixation of the Cervical Spine

Conclusion

To date, Roy-Camille et al^[4] have the largest reported clinical series of posterior cervical plating. In a retrospective review of 221 injuries of the lower cervical spine, posterior plate fixation was done in 89% of cases, with excellent or good results achieved in 85%. However, complications, specifically the incidence of neurovascular injury, were not well documented. In another report, Nazarian and Louis^[7] were able to achieve stability using posterior cervical plates in all 23 reported cases, with 20 of 23 patients returning to their preoperative functional status in less than 1 year. The 16 patients with preoperative radicular symptoms all reported complete relief postoperatively.

The risk of neurologic injury was evaluated by Cooper et al,^[2] who reviewed a preliminary experience of 20 patients treated with posterior cervical plates using the Roy-Camille method. None of the patients had postoperative nerve root or spinal cord injury. Nineteen spines maintained stability, and loss of alignment occurred in a single patient with ankylosing spondylitis. Jeanneret et al^[15] reviewed 51 patients who had stabilization with posterior cervical hook plates and lateral mass screws as described by Magerl. At follow-up, fusion was achieved in all patients without loss of alignment. Neurovascular injury resulting from lateral mass screw placement did not occur.

Anderson et al^[6] prospectively reviewed 30 patients with unstable cervical spine stabilized by a modified technique using posterior plates. A solid arthrodesis was achieved in all patients, and follow-up translation was within 0.5 mm of that obtained immediately postoperatively. No cases of neurovascular injury due to fixation were noted. Three screws were loose at follow-up, and two of the three screws appeared to violate the facet joint.

Standard wiring techniques for the treatment of fracture dislocations of the cervical spine are less effective if the posterior elements are absent or incompetent. Posterior cervical plating provides stronger immediate fixation stability and may be preferable in many of these clinical situations. Precise screw placement, however, is necessary to avoid neural or vertebral artery injury. Therefore, surgeons using this technique require an understanding of the cervical anatomy, screw placement methods, and clinical indications. The benefits of better immediate stability justify the potential risks of neurovascular complications.

J South Orthop Assoc. 2000;9(1) © 2000 Southern Medical Association

Cite this: Posterior Lateral Mass Plate Fixation of the Cervical Spine - Medscape - Mar 01, 2000.