POSTERIOR PLATING OF THE CERVICAL-SPINE

A retrospective review of 36 patients treated with posterior cervical plating and autogenous iliac crest bone graft was performed to evaluat e the results of posterior cervical plating in terms of fusion, outcom e, technique, and complications. Numerous methods of cervical stabiliz ation have been described with varying fusion rates and complications. Compared to wiring techniques, there is little information concerning the results of posterior cervical plating. Thirty-six patients with c ervical instability underwent posterior plating with lateral mass scre w fixation. Twenty-two had acute traumatic instability, four had late traumatic instability, six had metastatic disease, and four had postla minectomy spondylotic instability. A Minerva brace was worn postoperat ively for 3 months and fusion was assessed by bone incorporation on pl ain films, stable dynamic flexion-extension views, and absence of neck pain. Postoperative MRI and CT imaging was assessed in those patients who underwent these modalities. Fusion occurred at an average of 3 mo nths in all patients. One patient demonstrated postoperative neurologi c deterioration, but this resolved with subsequent decompression. Six patients had loosening of short, unicortical screws, but this did not affect the fusion result in five of these patients. The use of titaniu m implants allowed operative CT and MR imaging without the excessive a rtifact associated with stainless steel implants. Posterior cervical p lating with lateral mass fixation and bone grafting offers a reliable method of achieving fusion. Bicortical lateral mass screws are less li kely to loosen than unicortical screws, and no major complications occ urred.