Anterior Cervical Plate Introduction, Sizes, Uses and Advantages.

Anterior Cervical Plate

Anterior Cervical Plate Introduction

An anterior cervical plate (ACP) used to stabilise and support the spine after spinal fusion. The cervical spine refers to the vertebrae in the neck area, and fusion is the connecting of two or more vertebrae together to increase stability and relieve symptoms caused by disorders such as degenerative disc disease, herniated discs, or spinal fractures.

Anterior Cervical Plate is commonly screwed to the front (anterior) of the cervical spine. It is intended to keep the cervical vertebrae aligned and offer immediate support while the bones fuse together over childhood. The plate acts as an internal brace, preventing excessive movement and facilitating fusion.

Anterior Cervical Plate Sizes

Anterior Cervical Plate is a flat metal plate with screw holes along its length. Anterior Cervical Plate is made from Titanium.

Anterior Cervical Plates are available in various diameters and lengths.
Holes: 4, 6 and 8.
Lengths: 23mm, 25mm, 27mm, 29mm, 31mm, 33mm, 35mm, 37mm, 39mm, 41mm, 43mm, 45mm, 47mm, 49mm, 51mm, 53mm, 55mm, 57mm, 60mm, 63mm, 66mm, 69mm, 72mm, 75mm and 80 mm

Anterior Cervical Plate Uses

Anterior Cervical Plate is commonly used in the treatment of degenerative disorders of the cervical spine, tumors, trauma, and deformity.

Anterior cervical plate’s primary function is to preserve alignment and offer immediate stability following spinal fusion surgery. An incision in the front of the neck is usually made to provide the surgeon access to the cervical spine. The surgeon prepares the vertebrae for fusion by introducing bone graft material after removing damaged discs or bone spurs. The ACP is then placed over the prepped vertebrae and screwed into place.

Plate is anatomically shaped to accommodate the natural curve of the cervical spine. This increases the overall stability of the build by allowing for better contact with the vertebral bodies. The plate is normally left in place permanently, however in certain situations it may be removed after the fusion is complete.

Anterior Cervical Plate Advantage

Advantage of Anterior Cervical Plate:
Enhanced Stability: Anterior Cervical Plate functions as an internal bracing, preventing the fused vertebrae from moving excessively. It promotes fusion and provides stability during the first healing phase by restraining motion.

Improved Fusion Success: The plate assists in the distribution of stress and load over the fusion site, minimising strain on individual screws and promoting successful fusion. The support it provides produces an ideal environment for new bone formation, eventually resulting to a stable fusion between the vertebrae.

Reduced Recovery Time: Because the Anterior Cervical Plate provides instant stabilisation, patients can recover more pleasantly. The elimination of the requirement for external immobilisation devices such as neck braces improves mobility and allows for a quicker return to everyday activities.

Function Restoration: The goal of spinal fusion is to relieve symptoms and improve functionality. The ACP is important in supporting the spine, relieving pain, and restoring stability, all of which can improve the patient’s overall quality of life.

Anterior Cervical Plate Surgical Technique

Anterior cervical plating is commonly performed to stabilize anterior cervical fusions. Modern plating options include dynamic plates, with screws that can either toggle within fixed holes or translate within slotted holes. Regardless of the plating system used, paramount to success and avoidance of complications with plated anterior cervical fusions are meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft. In order to prevent graft-related complications associated with long-strut grafts, additional posterior fixation and fusion, or alternative corpectomy constructs, such as multilevel anterior cervical discectomy and fusion, corpectomy– discectomy, and corpectomy–corpectomy, should be considered instead if the pattern of stenosis allows.

Anterior Cervical Plate is commonly performed to stabilize anterior cervical fusions. Modern plating options include dynamic plates, with screws that can either toggle within fixed holes or translate within slotted holes. Regardless of the plating system used, paramount to success and avoidance of complications with plated anterior cervical fusions are meticulous plating techniques, exacting graft carpentry, and understanding the biomechanical limitations of plating in certain situations, such as multilevel corpectomies reconstructed with a single-strut graft. In order to prevent graft-related complications associated with long-strut grafts, additional posterior fixation and fusion, or alternative corpectomy constructs, such as multilevel anterior cervical discectomy and fusion, corpectomy– discectomy, and corpectomy–corpectomy, should be considered instead if the pattern of stenosis allows.

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Anterior Cervical Plate Contraindications

Contraindications may be qualified or total, and need to be taken into consideration when evaluating the prognosis in each case. The physician’s education, training and professional judgement must be relied upon to choose the most appropriate device and treatment. Conditions presenting an increased risk of failure include:

Any active or suspected latent infection or marked local inflammation in or about the affected area.
Compromised vascularity that would inhibit adequate blood supply to the fracture or the operative site.
Bone stock compromised by disease, infection or prior implantation that can not provide adequate support and/or fixation of the devices.
Material sensitivity, documented or suspected.
Obesity. An overweight or obese patient can produce loads on the implant that can lead to failure of the fixation of the device or to
failure of the device itself.
Patients having inadequate tissue coverage over the operative site.
Implant utilization that would interfere with anatomical structures or physiological performance.
Any mental or neuromuscular disorder which would create an unacceptable risk of fixation failure or complications in postoperative care.
Other medical or surgical conditions which would preclude the potential benefit of surgery.
All associated diseases which could endanger the function and success of the Anterior Cervical Plate.

Warnings and Precautionary for Anterior Cervical Plate

Before using Anterior Cervical Plate, the surgeon and ancillary staff should study the safety information in these instructions, as well as any product-specific information in the product description, surgical procedures and/or brochures.

Plate is made from medical grade materials and are designed, constructed and produced with utmost care. These quality Plate assure best working results provided they are used in the proper manner. Therefore, the following instructions for use and safety recommendations must be observed.

Improper use of Plate can lead to damage to the tissue, premature wear, destruction of the instruments and injury to the operator, patients or other persons.

It is vital for the operating surgeon to take an active role in the medical management of their patients. The surgeon should thoroughly understand all aspects of the surgical procedure and instruments including their limitations. Care in appropriate selection and proper use of surgical instruments is the responsibility of the surgeon and the surgical team. Adequate surgical training should be completed before use of implants.

Factors which could impair the success of the operation:

Allergies to implanted materials.
Localized bone tumours.
Osteoporosis or osteomalacia.
System disease and metabolic disturbances.
Alcohol and drug abuse.
Physical activities involving excessive shocks, whereby the implant is exposed to blows and/or excessive loading.
Patients who are mentally unable to understand and comply with the doctor’s instructions.
Poor general health.

Possible Adverse Effects

The following adverse effects are the most common resulting from implantation:

Loosening of the Plate, which may result from cyclic loading of the fixation site and/or tissue reaction of the implant.
Early and late infection.
Further bone fracture resulting from unusual stress or weakened bone substance.
Temporary or chronic neural damage resulting from pressure or hematomata.
Wound hematomas and delayed wound healing.
Vascular disease including venal thrombosis, pulmonary embolism and cardiac arrest.
Heterotopic ossification.
Pain and discomfort due to presence of the Anterior Cervical Plate.
Mechanical failure of the implant, including bending, loosening or breakage.
Migration of implant resulting in injury.

Preoperative Planning for Anterior Cervical Plate

The operating planning is carried out following a thorough clinical evaluation of the patient, Also, x-rays must be taken to allow a clear indication of the bony anatomy and associated deformities. At the time of the operation, the corresponding implantation instruments in addition to a complete size of Anterior Cervical Plate must be available.

The clinician should discuss with the patient the possible risks and complications associated with the use of implants. It is important to determine pre-operatively whether the patient is allergic to any of the implant materials. Also, the patient needs to be informed that the performance of the device cannot be guaranteed as complications can affect the life expectancy of the device.

Anterior Cervical Plate Precautions

Confirm functionality of instruments and check for wear during reprocessing. Replace worn or damaged instruments prior to use.
It is recommended to use the instruments identified for this Plate.
Handle devices with care and dispose worn bone cutting instruments in a sharps container.
Always irrigate and apply suction for removal of debris potentially generated during implantation or removal.

Anterior Cervical Plate Warnings

Anterior Cervical Plate can break during use (when subjected to excessive forces). While the surgeon must make the final decision on removal of the broken part based on associated risk in doing so, we recommend that whenever possible and practical for the individual patient, the broken part should be removed. Be aware that implants are not as strong as native bone. Implants subjected to substantial loads may fail.
Instruments, screws and cut plates may have sharp edges or moving joints that may pinch or tear user’s glove or skin.
Take care to remove all fragments that are not fixated during the surgery.
While the surgeon must make the final decision on implant removal, we recommend that whenever possible and practical for the individual patient, fixation devices should be removed once their service as an aid to healing is accomplished. Plate removal should be followed by adequate post-operative management to avoid refracture.

Anterior Cervical Plate General Adverse Events

As with all major surgical procedures, risks, side effects and adverse events can occur. While many possible reactions may occur, some of the most common include: Problems resulting from anesthesia and patient positioning (e.g. nausea, vomiting, dental injuries, neurological impairments, etc.), thrombosis, embolism, infection, nerve and/or tooth root damage or injury of other critical structures including blood vessels, excessive bleeding, damage to soft tissues incl. swelling, abnormal scar formation, functional impairment of the musculoskeletal system, pain, discomfort or abnormal sensation due to the presence of the device, allergy or hypersensitivity reactions, side effects associated with hardware prominence, loosening, bending, or breakage of the device, mal-union, non-union or delayed union which may lead to breakage of the Anterior Cervical Plate, reoperation.

Anterior cervical fusion: the role of Anterior Cervical Plate

Treatment of cervical pathology requires a clear understanding of the biomechanical benefits and limitations of Anterior Cervical Plates, their indications, and their associated complications. The use of anterior cervical plates has evolved significantly since their early application in cervical trauma. They have become widely used for anterior cervical decompression and fusion for cervical spondylosis. Plate design has undergone significant refinement and innovation, from the initial unlocked plates requiring bicortical purchase to the latest rotationally and translationally semiconstrained dynamic plates. Excellent clinical results have been reported for single-level anterior cervical decompression and fusion with or without plate fixation; however, the addition of an anterior cervical plate clearly leads to earlier fusion and better clinical results in longer fusions. Longer fusions should ideally consist of corpectomies and strut grafting because the decreased number of fusion surfaces tends to lead to higher fusion rates. Although anterior plate fixation leads to higher fusion rates in fusions of three or more levels, the associated pseudarthrosis rate is still high. The use of dynamic plates, through increased load sharing across the graft and decreased stress shielding, may improve fusion rates, particularly in long fusions. Nevertheless, adjuvant posterior fixation is recommended for fusions of more than three vertebral levels. Anterior plate fixation may be of particular benefit in the management of traumatic injuries, in revision settings, and in the treatment of smokers. Complications unique to plate fixation include hardware breakage and migration as well as ossification of the adjacent disk levels.

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Anterior Cervical Plate Introduction, Sizes, Uses and Advantages.