Clinical Experience with the Z-plate For Management of Fractures of the Thoracic and Lumbar Spine

John K Stokes, MD
John Iskandar, MD (Germany)
Richard Toselli, MD
Sharon Capps, RN (Chapel Hill, NC)

Introduction:

With the evolution of anterior thoracic and lumbar decompression and fusion in recent years, several constructs have been introduced as fixation devices. We have found the Z–plate (Sofamor Danek, Inc.) to be a versatile tool with many advantages compared to other fixation devices.

Methods:

Our clinical experience includes a prospective consecutive series of 41 patients over a period of 5 years with follow up from 1 to 57 months. The group consisted of 28 males and 13 females with ages from 12–78 years. Pathologies included 32 burst fractures, 6 metastic tumors, one tuberculous infection, one case of idiopathic fibrous replacement of the vertebral body and two thoracic discs with angulation and myelopathy. In all patients, corpectomy or discectomy was performed followed by grafting and instrumentation.

Results:

The ASIA grade remained stable in 35 patients and improved in six. The Cobb angle was used to measure kyphotic angulation and remained stable or improved in all but 4 patients one of which required posterior stabilization. Other complications included screw backout in 4 patients none of which required intervention. The length of hospitalization, length of procedure, estimated blood loss and type of graft used were also recorded.

Conclusion:

The advantages of the Z–plate include a low complication rate, MRI compatibility, ease of application, low profile and rigidity. It allows for short segment fixation and decompression in a single procedure. In addition, its ability to distract restores vertebral body height and reduces angulation.