Skip to main content

Advertisement

SpringerLink
Log in

Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Three different anterior plate-fixation systems are available for the stabilisation of the cervical spine: (1) the cervical spine locking plate (CSLP), (2) dynamic plates allowing vertical migration of the fixation screws, and (3) various types of plates that are secured with either monocortical or bicortical unlocked screws. Unicortical screw purchase does not involve the risk of posterior cortex penetration and possible injuries to the spinal cord. The development of locking plates with unicortical screw-fixation and intrinsic stability of the screw–plate interface, via an angle-stabilised connection, was an attempt to increase the stability of unicortical screw-fixation systems. The aim of the study was to compare the biomechanical properties of a non-locking, anterior-plate system with 4.5 mm screw fixation and a locking anterior-plate system, in a single destabilised cervical spine-motion segment. Using fresh cadaveric cervical spine specimen C3–C7, multidirectional flexibility was measured at the C4–C5 level in an unconstrained test system, before and after destabilisation and fixation with an anterior plate with either locked or unlocked screw purchase. Direct comparison of the fixed cervical spine segments with unlocked and locked anterior-plate fixation did not demonstrate significant differences. This in vitro study documented that neither locked nor unlocked anterior-plate fixation can increase stability in all modes of testing. H-plate spondylodesis with unlocked screws seems to provide sufficient mechanical integrity in most cases of monosegmental lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Aebi M, Zuber K, Marchesi D (1991) Treatment of cervical spine injuries with anterior plating. Indications, techniques, and results. Spine 16: S38–S45

    CAS  PubMed  Google Scholar 

  2. Banzer D, Felsenberg D (1989) Computerized tomography determination of bone mineral content in quantitative diagnosis of osteoporosis. Orthopade 18:12–17

    CAS  PubMed  Google Scholar 

  3. Berven S, Pedlow F (1999) A review of recent literature on the biomechanics of spinal instrumentation. Curr Opin Orthop 10:142–147

    Google Scholar 

  4. Blauth M, Schmidt U, Dienst M, Knop C, Lobenhoffer P, Tscherne H (1996) Long-term outcome of 57 patients after ventral interbody spondylodesis of the lower cervical spine. Unfallchirurg 99:925–939

    Article  CAS  PubMed  Google Scholar 

  5. Blauth M, Knop C, Bastian L, Lobenhoffer P (1997) New developments in surgery of the injured spine. Orthopade 26:437–449

    Article  CAS  PubMed  Google Scholar 

  6. Böhler J (1971) Operative Behandlung von Halswirbelsäulenverletzungen. Hefte Unfallheilkd 108:132–136

    PubMed  Google Scholar 

  7. Bohler J, Gaudernak T (1980) Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma 20:203–205

    PubMed  Google Scholar 

  8. Brown JA, Havel P, Ebraheim N, Greenblatt SH, Jackson WT (1988) Cervical stabilization by plate and bone fusion. Spine 13:236–240

    CAS  PubMed  Google Scholar 

  9. Cabanela ME, Ebersold MJ (1988) Anterior plate stabilization for bursting teardrop fractures of the cervical spine. Spine 13:888–891

    CAS  PubMed  Google Scholar 

  10. Caspar W, Barbier DD, Klara PM (1989) Anterior cervical fusion and Caspar plate stabilization for cervical trauma. Neurosurgery 25:491–502

    CAS  PubMed  Google Scholar 

  11. Clausen JD, Ryken TC, Traynelis VC, Sawin PD, Dexter F, Goel VK (1996) Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model. J Neurosurg 84:1039–1045

    CAS  PubMed  Google Scholar 

  12. Coe JD, Warden KE, Sutterlin CE III, McAfee PC (1989) Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine 14:1122–1131

    CAS  PubMed  Google Scholar 

  13. Gallagher MR, Maiman DJ, Reinartz J, Pintar F, Yoganandan N (1993) Biomechanical evaluation of Caspar cervical screws: comparative stability under cyclical loading. Neurosurgery 33:1045–1050

    CAS  PubMed  Google Scholar 

  14. Garvey TA, Eismont FJ, Roberti LJ (1992) Anterior decompression, structural bone grafting, and Caspar plate stabilization for unstable cervical spine fractures and/or dislocations. Spine 17:S431-S435

    CAS  PubMed  Google Scholar 

  15. Gassman J, Seligson D (1983) The anterior cervical plate. Spine 8:700–707

    CAS  PubMed  Google Scholar 

  16. Goffin J, van Loon J, Van Calenbergh F, Plets C (1995) Long-term results after anterior cervical fusion and osteosynthetic stabilization for fractures and/or dislocations of the cervical spine. J Spinal Disord 8:500–508

    CAS  PubMed  Google Scholar 

  17. Grubb MR, Currier BL, Shih JS, Bonin V, Grabowski JJ, Chao EY (1998) Biomechanical evaluation of anterior cervical spine stabilization. Spine 23:886–892

    Article  CAS  PubMed  Google Scholar 

  18. Hoffmann R, McKellop HA, Sarmiento A, Lu B, Ebramzadeh E (1991) Three-dimensional measurement of fracture gap motion. Biomechanical study of experimental tibial fractures with anterior clasp fixator and ring fixator. Unfallchirurg 94:395–400

    CAS  PubMed  Google Scholar 

  19. Lehmann W, Blauth M, Briem D, Schmidt U (2004) Biomechanical analysis of anterior cervical spine plate fixation system with unicortical and bicortical screw purchase. Eur Spine J 13:69–75

    Article  PubMed  Google Scholar 

  20. Orozco DR, Llovet-Tapies J (1970) Osteosintesis en las fractures de raquis cervical. Revista Orthop Traumatol 14:285–288

    Google Scholar 

  21. Panjabi MM (1988) Biomechanical evaluation of spinal fixation devices: I. A conceptual framework. Spine 13:1129–1134

    CAS  PubMed  Google Scholar 

  22. Panjabi MM (1998) Cervical spine models for biomechanical research. Spine 23:2684–2700

    Article  CAS  PubMed  Google Scholar 

  23. Pitzen T, Wilke HJ, Caspar W, Claes L, Steudel WI (1999) Evaluation of a new monocortical screw for anterior cervical fusion and plating by a combined biomechanical and clinical study. Eur Spine J 8:382–387

    CAS  PubMed  Google Scholar 

  24. Pitzen T, Barbier D, Tintinger F, Steudel WI, Strowitzki M (2002) Screw fixation to the posterior cortical shell does not influence peak torque and pullout in anterior cervical plating. Eur Spine J 11:494–499

    Article  CAS  PubMed  Google Scholar 

  25. Pitzen T, Lane C, Goertzen D, Dvorak M, Fisher C, Barbier D, Steudel WI, Oxland T (2003) Anterior cervical plate fixation: biomechanical effectiveness as a function of posterior element injury. J Neurosurg 99:84–90

    PubMed  Google Scholar 

  26. Randle MJ, Wolf A, Levi L, Rigamonti D, Mirvis S, Robinson W, Bellis E, Greenberg J, Salcman M (1991) The use of anterior Caspar plate fixation in acute cervical spine injury. Surg Neurol 36:181–189

    Article  CAS  PubMed  Google Scholar 

  27. Richter M, Wilke HJ, Kluger P, Claes L, Puhl W (1999) Biomechanical evaluation of a newly developed monocortical expansion screw for use in anterior internal fixation of the cervical spine. In vitro comparison with two established internal fixation systems. Spine 24:207–212

    Article  CAS  PubMed  Google Scholar 

  28. Ripa DR, Kowall MG, Meyer PR Jr, Rusin JJ (1991) Series of 92 traumatic cervical spine injuries stabilized with anterior ASIF plate fusion technique. Spine 16: S46-S55

    CAS  PubMed  Google Scholar 

  29. Ryken TC, Goel VK, Clausen JD, Traynelis VC (1995) Assessment of unicortical and bicortical fixation in a quasistatic cadaveric model. Role of bone mineral density and screw torque. Spine 20:1861–1867

    CAS  PubMed  Google Scholar 

  30. Smith SA, Lindsey RW, Doherty BJ, Alexander J, Dickson JH (1995) An in-vitro biomechanical comparison of the Orosco and AO locking plates for anterior cervical spine fixation. J Spinal Disord 8:220–223

    CAS  PubMed  Google Scholar 

  31. Spivak JM, Chen D, Kummer FJ (1999) The effect of locking fixation screws on the stability of anterior cervical plating. Spine 24:334–338

    Article  CAS  PubMed  Google Scholar 

  32. Tscherne H, Hiebler G, Muhr G (1971) Zur operativen Behandlung von Frakturen und Luxationen der Halswirbelsäule. Hefte Unfallheilkd 142–144

  33. White AA, Panjabi MM (1990) Clinical Biomechanics of the spine. Lippincott, Philadelphia

  34. Wilke HJ, Wenger K, Claes L (1998) Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J 7:148–154

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Supported by the German Research Foundation, DFG, Bonn, Germany

Author information

Authors and Affiliations

  1. Department of Trauma Surgery, Hannover Medical School, Hannover, Germany

    Wolfgang Lehmann

  2. Department of Trauma Surgery, Hamburg University School of Medicine, Hamburg, Germany

    Wolfgang Lehmann & Daniel Briem

  3. Department of Trauma Surgery, University Clinic, Innsbruck, Austria

    Michael Blauth

  4. Department of Trauma Surgery, Krankenhaus der Barmherzigen Schwestern in Ried, Schlossberg 1, 4910, Ried, Austria

    Ulf Schmidt

Authors
  1. Wolfgang Lehmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Daniel Briem
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Blauth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ulf Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ulf Schmidt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lehmann, W., Briem, D., Blauth, M. et al. Biomechanical comparison of anterior cervical spine locked and unlocked plate-fixation systems. Eur Spine J 14, 243–249 (2005). https://doi.org/10.1007/s00586-004-0746-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-004-0746-9

Keywords

Search

Navigation