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The authors present a retrospective
series of 51 cases of cervical myelopathy and/or radiculopathy;
all underwent cervical interbody fusion and plating using a new
cervical plating system for the treatment of cervical degenerative
disease (Atlantis (tm) Medtronic, Sofamor Danek, Memphis, TN).
This system is unique because consists of a choice between fixed,
variable, and hybrid bone screw angles allowing pivot screws
for controlled subsidence.
The series is composed of 21
males and 30 females with a mean age of 45.8 years. There were
15 smokers in the group. All patients presented with symptoms
of cervical myelopathy and/ or radiculopathy, and demonstrated
radiographic nerve root and/or spinal cord compression at one
or more cervical levels. Twenty–two patients underwent single
level ACDF, 11 patients underwent single level corpectomy, 3
patients were treated with multilevel corpectomy without posterior
instrumentation, 8 patients underwent multilevel ACDF without
posterior instrumentatior4 and 7 patients were treated with 1–
4 level corpectomy supplemented with posterior instrumentation.
In all patients except one, fibular allograft was used in the
fusion construct. Fusion was determined at follow–up by
static and dynamic plain radiographs and was defined as: the
absence of lucency around the graft, an increase in subchondral
endplate sclerosis, bridging bone between the graft and endplates,
and absence of movement on dynamic radiographs. Cervical lordosis
was followed with a modified Cobb angle; the modified Cobb angle
was measured on immediate postoperative films and compared to
the measurement at follow up. Outcomes were assessed clinically
using a 4 tiered outcome scale based on the Prolo system, and
were rated as excellent, good, fair or poor.
The mean follow up interval for
the patients was 7.6 months. Excellent or good outcomes were
seen in 82 percent of patients; results were stratified by fixed,
variable, and hybrid bone screw constructs, and no significant
difference was found in clinical outcome by construct type (p<.05,
paired t test). Osseous fusion was seen in 96 percent of the
patients, with no difference in fusion by construct type (p<.05).
The overall change in modified Cobb angle for all three types
of constructs was 3.36 degrees of kyphosis, with no significant
difference in Cobb angle change by construct type (p<.05).
Complications included one episode of chronic wound drainage
treated with intravenous antibiotics and one postoperative wound
infection, which required re–operation and intravenous antibiotics.
Initial results indicate that
the Atlantis (tm) cervical plating system provides fusion rates
and clinical outcomes which are comparable to other locking anterior
cervical plating systems. It also has the unique advantage of
providing three types of bone screw constructs, which makes the
system effective over the wide range of anatomic requirements
presented in anterior cervical fixation.
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