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In retrospectively analyzing 35 consecutive patients with chronic spondylotic radiculopathy treated by nerve root decompression, interbody fusion (Robinson technique), and plating, we studied the perioperative complication rate as well as the long-term clinical and radiologic outcomes of an additional plate fixation in degenerative cervical disorders. After an average of 54 months (range 24-102 months), all cases were reviewed for the purpose of this study. There were no perioperative or postoperative complications related to the plate fixation. In particular, there was no infection, graft extrusion, or neurologic deterioration. A solid fusion was obtained in all cases with a single-level fusion and in 87% of the cases with a multilevel fusion. The overall fusion rate was 94%. The clinical outcome of the patients with chronic radiculopathy was comparable with that in the literature, with only three patients (8.6%) having a poor result. This study demonstrated that plate fixation can be a useful adjunct in patients undergoing interbody fusion for cervical spondylotic radiculopathy. Plate fixation seems to reduce the rate of nonunion without additional hazards for the patient. This report should form the basis for a prospective randomized trial to answer the question more conclusively of whether an additional plate fixation is superior to uninstrumented cervical fusion in degenerative disorders.

From 1985 through 1990, 19 patients with tumorous conditions of the cervical spine and the first two thoracic vertebrae were treated with anterior, posterior, or combined anterior/posterior surgical techniques. Breast metastases were by far the most common condition (42%). Patients usually experienced severe pain, which resisted conservative treatment, sometimes associated with radiculopathies (42%) or neurological deficits (31%). To date, the treatment of spinal tumors is only palliative, and surgery must be considered for cases with unremitting neck pain, major vertebral destruction with loss, or impending loss of cervical spine stability and neurological deficits due to local tumor compression. Contrary to the commonly used posterior wiring stabilizations, we preferred stabilization techniques more closed to those used in traumatology. Our findings suggest anterior surgery alone with vertebrectomy and stabilization with plate and bone cement for tumors involving only one vertebra and localized between C3 and T1. Posterior approach and stabilization is advocated for atlantoaxial lesions. A combined anterior and posterior technique should be reserved for extended tumoral conditions where an anterior fixation does not offer enough stability or where more radical surgery is required. In the present series, immediate good spinal stabilization and neck pain relief was obtained in every case, allowing early mobilization. Improvement of the neurologic deficit was noted in 65% of our patients.

We retrospectively analyzed the frequency and clinical consequences of pedicular fixation system failure in 50 patients who underwent Cotrel-Dubousset transpedicular instrumentation (CDI), and 46 patients who underwent AO internal fixator (IF) instrumentation for similar indications. After 2 years, 14 implants in the CDI group and 13 in the IF group had failed. The overall probability of implant survival was similar in both groups (CDI, 71.9% versus IF, 71.7%). However, more implant failures were associated with nonunion, loss of reduction, and nerve-root compromise in the IF group (four versus none) than in the CDI group. Implant failure usually occurred after solid fusion, and did not significantly affect the short-term clinical results. Therefore, implant failure does not a priori indicate failure of the operation.

We treated 50 consecutive patients with Cotrel-Dubousset instrumentation (CDI) for symptomatic spondylolisthesis. Average follow-up was 25 months. Fusion in situ was performed in 32 of 44 patients with mild spondylolisthesis, while 12 patients had reduction in conjunction with neural decompression. Two of six patients with severe spondylolisthesis who were treated via a single posterior approach had loss of reduction and nonunion. In another patient a Grade III spondylolisthesis could not be reduced via a posterior approach. Seventy-six percent of the patients had a good clinical result. The rate of solid fusion was 96%. One nerve root compromise recovered completely. One superficial wound infection healed uneventfully. This study suggests that combined anterior and posterior fusion is required for permanent and sufficient correction of severe spondylolisthesis even with CDI. Low-grade spondylolisthesis should be reduced only in conjunction with neural decompression.