Biomechanical performance of rigid compared to dynamic anterior cervical plating: analysis of adjacent upper and lower level compressive forces

Dynamic anterior cervical plating is well established as a means of enhancing graft loading and subsequent arthrodesis. Current concerns center on the degree of adjacent-level stress induced by these systems. The aim of this study was to evaluate and compare the load transferred to adjacent levels for single-level anterior cervical discectomy and fusion utilizing rigid compared to dynamic anterior plating systems. Nine cadaveric adult human cervical spine specimens were subjected to range-of-motion testing prior to and following C5-C6 anterior cervical discectomy and fusion procedures. Interbody grafting was performed with human fibula tissue. Nondestructive biomechanical testing included flexion/extension and lateral bending loading modes. A constant displacement of 5mm was applied in each direction and the applied load was measured in newtons (N). Specimens were tested in the following order: intact, following discectomy, after rigid plating, then after dynamic plating. Adjacent level (C4-C5 [L(S)] and C6-C7 [L(I)]) compressive forces were measured using low profile load cells inserted into each disc space. The measured load values for plating systems were then normalized using values measured for the intact specimens. Mean loads transferred to L(S) and L(I) during forced flexion in specimens with rigid plating were 23.47 N and 8.76 N, respectively; while the corresponding values in specimens with dynamic plating were 18.55 N and 1.03 N, respectively. Dynamic plating yielded no significant change at L(I) and a 21.0% decrease in load at L(S) when compared with rigid plating, although the difference was not significant. The observed trend suggests that dynamic plating may diminish superior adjacent level compressive stresses.