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Misaligned Versus Straight Placement of Anterior Cervical Plates: A Clinical and Radiologic Outcomes Study

Chin, Kingsley R. MD; Pencle, Fabio J.R. MD; Francis, Shannon D. BA; Francis, Chloe A. BA; Seale, Jason A. MBBS; Hothem, Elijah A. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 389–395
doi: 10.5435/JAAOS-D-16-00332
Research Article

Background: In anterior cervical diskectomy and fusion (ACDF), misaligned plates are concerning because of the risk of screw-and-plate failure; however, these plates also hypothetically have the potential for asymmetric micromotion on the facet and uncovertebral joint. The aim of this study was to determine whether misaligned plate placement during ACDF had clinical benefits compared with straight plate placement.

Methods: Postoperative AP radiographs of 128 consecutive patients who underwent ACDF with anterior cervical plate (ACP) fixation were reviewed, and plate alignment was assessed. Patients were separated into control group 1 (straight plates) or group 2 (misaligned plates).

Results: The mean age of patients was 51.5 ± 0.9 years, and women represented 51% of the total population. There was no significant difference between groups with regard to the preoperative visual analog scale (VAS) and Neck Disability Index (NDI) scores (P = 0.744 and P = 0.943, respectively). At 6 weeks postoperatively, the VAS scores for group 1 decreased from 7.6 ± 0.2 to 4.0 ± 0.2 compared with the scores in group 2, which decreased from 7.7 ± 0.2 to 2.1 ± 0.1, which demonstrated statistical significance (P = 0.019). At 2-year follow-up, no significant difference was demonstrated between the groups’ VAS and NDI scores (P = 0.670 and P = 0.266).

Conclusion: Misaligned plates have increased torsional strength and are associated with better clinical outcomes compared with those of straight plates in the early postoperative period. After fusion, no significant difference in clinical outcomes between the groups was noted, which may reduce the concerns regarding misaligned plates.

Level of Evidence: Retrospective comparative study

From the Department of Clinical and Biomedical Sciences, Florida Atlantic University, Boca Raton, FL, the Department of Orthopedics, Florida International University, Miami, FL (Dr. Chin), and the LESS Institute, Miami (Dr. Chin, Dr. Pencle, Ms. S. Francis, Ms. C. Francis, Dr. Seale, and Dr. Hothem).

Correspondence to Dr. Chin:

Dr. Chin or an immediate family member has stock or stock options held in SpineFrontier; has received research or institutional support from the Less Exposure Surgery Society; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from SpineFrontier; and serves as a board member, owner, officer, or committee member of the Less Exposure Surgery Society. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Pencle, Ms. S. Francis, Ms. C. Francis, Mr. Seale, and Dr. Hothem.

Received May 02, 2016

Received in revised form August 29, 2016

Accepted November 16, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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