Anterior subaxial cervical spine fixation using a plate with single screw per vertebral body: A simple and efficient construct - Clinical series and a cadaver study

Objective: To report our experience with a novel construct for traumatic and nontraumatic cervical spine lesions that was validated by biomechanical studies of cadaver cervical spine.
Study Design: Consecutive cases of anterior cervical spine fixation performed over six years reviewed for stability offered by a construct comprising of a plate fixed by a single screw to each vertebral body.
Setting: A university hospital and a biomechanical lab.
Materials and Methods: Data were coded and entered into a statistical worksheet for multivariate analysis. Cadaver spine models applied for biomechanical study of stability.
Results: Total of 103 cases reviewed; 86 with single-level disease; traumatic in 66 (64%) cases and degenerative in 33 (32%) cases, including hard disks, OPLL, and spondylitis (4% with other causes). Fixation was with diskectomy in 59 and with corpectomy in 40. A bone graft was utilized for fusion in 87 and a bone-filled titanium spacer in 13. A single screw was placed in each vertebral body with a locking plate (having linear arrangement of holes). This construct remained strong in 95% of cases at the end of 6-24 months. Five cases failed requiring reoperation. Five patients with cervical spinal cord injury (SCI) died. On statistical analysis, construct was stronger with diskectomy compared with corpectomy. Construct used on cadavers confirmed the biomechanical stability in short segment fixation (C5-6).
Conclusion: A conservative construct utilizing a single screw per vertebral body and a one-holed plate system appears to be strong enough to afford stability in both traumatic and nontraumatic lesions of subaxial cervical spine, comparable to others.