Stress-shielding compared with load-sharing anterior cervical plate fixation: A clinical and radiographic prospective analysis of 50 patients

Paul Saphier, Marc S. Arginteanu, Frank M. Moore, Alfred A. Steinberger, Martin B. Camins

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Object. In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained in the two cohorts were analyzed to determine whether clinical or radiographic differences would emerge. Methods. All patients underwent either one- or two-level fusion in which freeze-dried allogenic tricortical iliac crest bone graft was used. In the first cohort of 25 patients entered into the study, fixation was achieved using a stress-shielding anterior cervical plate (ACP) system, whereas in the second cohort of 25 patients a load-sharing plate system was employed. Patients were evaluated during a follow-up period that ranged from 12 to 35 months. Outcome was determined using a standard questionnaire by which the authors gauged the level of pain, disability, and satisfaction following surgery. The success of surgical fusion and the magnitude of the translation were determined by radiographic evaluation. There was no statistically significant difference between the two cohorts with respect to age, sex, smoking rate, and postoperative complications. With regard to pain and functionality, there was a significant difference (p < 0.05) in favor of the load-sharing system. The fusion rates with the load-sharing and stress-shielding systems were 96 and 92%, respectively, and this difference was not significant. There was no significant difference between the two cohorts with regard to overall satisfaction. The magnitude of vertical translation was significantly greater in the stress-shielding ACP group (p < 0.05) for treatment at one level but not at two. Clinical and radiographic data were available in all patients. Conclusions. Load-sharing ACP systems exhibited superior clinical results compared with stress-shielding ACPs in this series of patients. The symptomatic pseudarthrosis rate was lower in the load-sharing ACP-treated patients, although this was not statistically significant.

Original languageEnglish (US)
Pages (from-to)391-397
Number of pages7
JournalJournal of Neurosurgery: Spine
Volume6
Issue number5
DOIs
StatePublished - May 1 2007

Fingerprint

Pain
Diskectomy
Pseudarthrosis
Smoking
Transplants
Bone and Bones
Therapeutics
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Saphier, Paul ; Arginteanu, Marc S. ; Moore, Frank M. ; Steinberger, Alfred A. ; Camins, Martin B. / Stress-shielding compared with load-sharing anterior cervical plate fixation : A clinical and radiographic prospective analysis of 50 patients. In: Journal of Neurosurgery: Spine. 2007 ; Vol. 6, No. 5. pp. 391-397.
@article{0db515fb9c0543ffa2a04ac5a1f19cfc,
title = "Stress-shielding compared with load-sharing anterior cervical plate fixation: A clinical and radiographic prospective analysis of 50 patients",
abstract = "Object. In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained in the two cohorts were analyzed to determine whether clinical or radiographic differences would emerge. Methods. All patients underwent either one- or two-level fusion in which freeze-dried allogenic tricortical iliac crest bone graft was used. In the first cohort of 25 patients entered into the study, fixation was achieved using a stress-shielding anterior cervical plate (ACP) system, whereas in the second cohort of 25 patients a load-sharing plate system was employed. Patients were evaluated during a follow-up period that ranged from 12 to 35 months. Outcome was determined using a standard questionnaire by which the authors gauged the level of pain, disability, and satisfaction following surgery. The success of surgical fusion and the magnitude of the translation were determined by radiographic evaluation. There was no statistically significant difference between the two cohorts with respect to age, sex, smoking rate, and postoperative complications. With regard to pain and functionality, there was a significant difference (p < 0.05) in favor of the load-sharing system. The fusion rates with the load-sharing and stress-shielding systems were 96 and 92{\%}, respectively, and this difference was not significant. There was no significant difference between the two cohorts with regard to overall satisfaction. The magnitude of vertical translation was significantly greater in the stress-shielding ACP group (p < 0.05) for treatment at one level but not at two. Clinical and radiographic data were available in all patients. Conclusions. Load-sharing ACP systems exhibited superior clinical results compared with stress-shielding ACPs in this series of patients. The symptomatic pseudarthrosis rate was lower in the load-sharing ACP-treated patients, although this was not statistically significant.",
author = "Paul Saphier and Arginteanu, {Marc S.} and Moore, {Frank M.} and Steinberger, {Alfred A.} and Camins, {Martin B.}",
year = "2007",
month = "5",
day = "1",
doi = "10.3171/spi.2007.6.5.391",
language = "English (US)",
volume = "6",
pages = "391--397",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "5",

}

Stress-shielding compared with load-sharing anterior cervical plate fixation : A clinical and radiographic prospective analysis of 50 patients. / Saphier, Paul; Arginteanu, Marc S.; Moore, Frank M.; Steinberger, Alfred A.; Camins, Martin B.

In: Journal of Neurosurgery: Spine, Vol. 6, No. 5, 01.05.2007, p. 391-397.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stress-shielding compared with load-sharing anterior cervical plate fixation

T2 - A clinical and radiographic prospective analysis of 50 patients

AU - Saphier, Paul

AU - Arginteanu, Marc S.

AU - Moore, Frank M.

AU - Steinberger, Alfred A.

AU - Camins, Martin B.

PY - 2007/5/1

Y1 - 2007/5/1

N2 - Object. In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained in the two cohorts were analyzed to determine whether clinical or radiographic differences would emerge. Methods. All patients underwent either one- or two-level fusion in which freeze-dried allogenic tricortical iliac crest bone graft was used. In the first cohort of 25 patients entered into the study, fixation was achieved using a stress-shielding anterior cervical plate (ACP) system, whereas in the second cohort of 25 patients a load-sharing plate system was employed. Patients were evaluated during a follow-up period that ranged from 12 to 35 months. Outcome was determined using a standard questionnaire by which the authors gauged the level of pain, disability, and satisfaction following surgery. The success of surgical fusion and the magnitude of the translation were determined by radiographic evaluation. There was no statistically significant difference between the two cohorts with respect to age, sex, smoking rate, and postoperative complications. With regard to pain and functionality, there was a significant difference (p < 0.05) in favor of the load-sharing system. The fusion rates with the load-sharing and stress-shielding systems were 96 and 92%, respectively, and this difference was not significant. There was no significant difference between the two cohorts with regard to overall satisfaction. The magnitude of vertical translation was significantly greater in the stress-shielding ACP group (p < 0.05) for treatment at one level but not at two. Clinical and radiographic data were available in all patients. Conclusions. Load-sharing ACP systems exhibited superior clinical results compared with stress-shielding ACPs in this series of patients. The symptomatic pseudarthrosis rate was lower in the load-sharing ACP-treated patients, although this was not statistically significant.

AB - Object. In a prospective analysis the authors evaluated the clinical and radiographic outcome of 50 consecutive patients who underwent anterior cervical discectomy and fusion and fixation in which either a stress-shielding or a load-sharing plate (Orion and Premier, respectively) was placed. Data obtained in the two cohorts were analyzed to determine whether clinical or radiographic differences would emerge. Methods. All patients underwent either one- or two-level fusion in which freeze-dried allogenic tricortical iliac crest bone graft was used. In the first cohort of 25 patients entered into the study, fixation was achieved using a stress-shielding anterior cervical plate (ACP) system, whereas in the second cohort of 25 patients a load-sharing plate system was employed. Patients were evaluated during a follow-up period that ranged from 12 to 35 months. Outcome was determined using a standard questionnaire by which the authors gauged the level of pain, disability, and satisfaction following surgery. The success of surgical fusion and the magnitude of the translation were determined by radiographic evaluation. There was no statistically significant difference between the two cohorts with respect to age, sex, smoking rate, and postoperative complications. With regard to pain and functionality, there was a significant difference (p < 0.05) in favor of the load-sharing system. The fusion rates with the load-sharing and stress-shielding systems were 96 and 92%, respectively, and this difference was not significant. There was no significant difference between the two cohorts with regard to overall satisfaction. The magnitude of vertical translation was significantly greater in the stress-shielding ACP group (p < 0.05) for treatment at one level but not at two. Clinical and radiographic data were available in all patients. Conclusions. Load-sharing ACP systems exhibited superior clinical results compared with stress-shielding ACPs in this series of patients. The symptomatic pseudarthrosis rate was lower in the load-sharing ACP-treated patients, although this was not statistically significant.

UR - http://www.scopus.com/inward/record.url?scp=34347269246&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34347269246&partnerID=8YFLogxK

U2 - 10.3171/spi.2007.6.5.391

DO - 10.3171/spi.2007.6.5.391

M3 - Article

C2 - 17542503

AN - SCOPUS:34347269246

VL - 6

SP - 391

EP - 397

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 5

ER -