Anterior Cervical Plate: An Option in Cervical Spine Surgery

Paul C. McCormick, M.D., M.P.H., F.A.C.S.
Professor of Clinical Neurosurgery
Columbia University College of Physicians and Surgeons
New York, NY
Susan Spinasanta
Senior Medical Editor
SpineUniverse
Desert Hot Springs, CA
Every year neck pain affects millions of people. Most patients respond well to non-surgical treatments such as medication and physical therapy. However, a small percentage of patients may find nonsurgical interventions fail to relieve pain. Symptoms persist, which may include severe pain and neurologic dysfunction. Neck, arm pain and other symptoms may occur when a cervical intervertebral disc herniates. A disc herniates when some of the disc’s gel-like center (the nucleus pulposus) bulges or ruptures through the tough tire-like outer ring (the annulus fibrosus) and presses on nerve roots or the spinal cord. This is called nerve compression.

normal disc, vertebra, nerves
herniated disc

If surgery is needed to alleviate nerve or spinal cord compression, the surgeon may perform a procedure called an anterior cervical discectomy and fusion. In this procedure the surgeon makes a small incision in the front of the neck to reach the cervical spine. Tissues and muscles are retracted (spread apart) to reveal the proper level in the cervical spine. The disc is removed and the space is filled with bone graft. A cervical plate is screwed into the superior (top) and inferior (bottom) vertebral bodies, which stabilizes the cervical spine facilitating fusion and healing.

Cervical Plate History
Cervical plates have been used for more than 20 years to increase neck stability following single and multi-level cervical surgery. These devices are improving the success rates of fusion in cervical spine surgery. The stability cervical plates provide may decrease the patient’s need to wear a cervical collar post-operatively. There are several cervical plate options, but this article will focus on one cervical plate. You can read more about other cervical plate options in the article on anterior cervical fixation.

Advantages of New Plate Design

  • Of all other cervical plates available on the market today, ZEPHIR™ has the lowest profile. This means it is the thinnest. The plate construct when completely implanted is only 1.6mm high and 15mm wide. This is small considering one millimeter equals 0.03937th's an inch.

  • The plate is made from titanium alloy, which means it is strong. The low profile design does not compromise the plate’s strength. Its metal fatigue properties, or ability to resist breakdown when subjected to stress, are similar to other plates now in clinical use.

  • The plates are made with a pre-machined lordotic (forward) curve to restore and maintain proper curvature of the cervical spine. Further, a plate-bending tool enables the surgeon to customize the plate’s lordotic curvature to meet the patient’s needs.

  • Cervical plates are available in a range of sizes for use in one or multiple anterior cervical fusions.

  • Variable screw design allows the surgeon to choose screw placement and trajectory into the vertebrae. The screws are self-locking and an interlocking cap system prevents the screws from loosening or backing out.

  • Disturbance of the patient’s anatomy is minimized by this plate’s design.
Last Updated: 08/07/2009
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Editorial Board Comments on SpineUniverse
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Peer Review by Leading Specialists

    Todd J. Albert, MD

    Anterior cervical instrumentation has significantly improved patients' quality of life after anterior cervical discectomy and fusion (ACDF). The use of plating in single level surgery allows freedom of neck motion early obviating the need for a hard cervical collar. Two level plating improves the fusion rate while also decreasing orthotic rigidity. Many excellent plates, such as the one described in this article, are now available. What we still have not answered are questions related to the optimal plate type: static versus dynamic and the best way to achieve dynamization. Dynamization can be achieved via plate malleability, sliding, or variability in screw design and implantation. More studies are needed in vitro and in vivo to determine this answer. The minimum criteria for a plate are: ease of installation, confidence that the locking mechanism of screws cannot fail, acceptable profile, and that the installation steps are foolproof. The plate described here appears to satisfy these. We await more clinical studies to prove any advantages.
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