Rigid internal fixation with lateral mass plates in multilevel anterior and posterior reconstruction of the cervical spine

Study Design, A retrospective clinical and radiographic analysis was performed on 17 patients with multilevel cervical disease who were treated with anterior and posterior reconstruction with a new rigid, segmental, internal fixation system applied to the lateral masses. Objectives. To determine the applicability, safety, and clinical efficacy of an instrumentation system used as a cervical lateral mass plate in the management of complex spinal disorders. Summary of Background Data. Cervical disorders involving three or more levels present a difficult reconstruction problem, especially if the posterior elements are deficient. Segmental fixation with lateral mass plating provides an alternative method to situations that would otherwise require a halo. Methods. Seventeen patients treated by a single surgeon underwent cervical reconstruction surgery involving three or more levels. All patients had anterior decompression and reconstruction and a posterior fusion with rigid internal fixation with a device applied to the lateral masses of the cervical vertebrae. Patients were reviewed clinically and radiographically to determine the efficacy and safety of this method of fixation. Results. Of the 15 patients with adequate follow-up data that were studied, the condition of 13 patients (87%) was improved, that of one patient (6.7%) was the same, and that of another (6.7%) was worse after surgical intervention. Sagittal alignment was restored to within 5 degrees of the preoperative lordosis in active extension by the modified Cobb method and the Gore method. No patient had radiographic nonunion. One patient had a sensory radiculopathy associated with an overpenetrated lateral mass screw that partially resolved after hardware removal. One patient had asymptomatic loosening of a C7 lateral mass screw. Conclusions. Segmental posterior fixation with lateral mass plating provides more rigid immobilization than traditional techniques, allows restoration and maintenance of spinal alignment, obviates the need for halo immobilization, and is associated with a low incidence of neurovascular injury.