PubMed · 9181515
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K Klaue. 1997. Titanium plate fixation.. https://doi.org/10.1097/00005131-199704000-00024
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STUDY DESIGN: A retrospective analysis of graft and plate complications after multilevel anterior cervical corpectomy and fusion (ACF) attributed to spondylosis, stenosis, and ossification of posterior longitudinal ligament was conducted. OBJECTIVE: To identify factors contributing to graft and plate complications in this population. SUMMARY OF BACKGROUND DATA: Biomechanical factors contributing to the increased morbidity associated with plated multilevel ACF were evaluated. METHODS: Graft- and/or plate-related complications were retrospectively reviewed in 33 patients undergoing two-level ACF reconstructions and in seven patients having three-level ACF reconstructions performed with iliac crest grafting and instrumentation with a fixed-plated design (cervical spine locking plate). Neurologic status was assessed before surgery and after surgery using both the Nurick Grading Scale and modified JOA (Japanese Orthopaedic Association) Score. The patients were observed an average of 31.4 months after surgery. The follow-up included lateral flexion and extension radiographs and a neurologic examination. RESULTS: Two of the 33 patients undergoing two-level fusions available for long-term follow-up after surgery developed reconstruction failures. All of the remaining fusions were successful, demonstrated by lateral flexion and extension radiographs. Seven patients had plated three-level corpectomy reconstructions. Five of the seven who had anterior-only reconstruction failed. DISCUSSION: A two-level ACF reconstruction is reliable with an anterior strut graft and fixed screw plate construct. A three-level ACF reconstruction is not reliably achieved with an anterior-only construct. The construct failures may be attributed in part to the fixed-plated design being used, as well as the long lever arm of the construct. CONCLUSION: There is a 6% failure rate after fixed-plated (cervical spine locking plate) two-level ACF reconstruction but a 71% failure rate after three-level fixed-plated ACF reconstruction. Future consideration should be given to simultaneous posterior fusion.
Optical microscopy, scanning electron microscopy and X-ray microanalysis (EDS system) were used on c.p. titanium devices (21 grids and 10 plates) removed from 28 patients without signs of inflammation 6-24 months after surgery. Plates, grids and surrounding tissue were investigated to evaluate the titanium release and accumulation. Titanium was only present in the interfacial bone, probably due to fretting, and in all fibrous tissue surrounding the devices. Titanium content followed a decreasing gradient extending from the device surface and was not detected at a distance greater than 1mm. High titanium levels were found in blood cells in the connective tissue. In conclusion, titanium release from the devices stops only after bone is laid down on the titanium surfaces. Titanium release does not seem to interfere with the osteogenic process but perhaps may interact with it.
BACKGROUND: A method is introduced using a newly developed palatal distractor, which allows rapid transversal widening in cases of maxillary compression. METHODS: After osteotomy of the palate parallel to the sutura palatina mediana as well as to the lateral walls of the maxillary sinuses, the applied distractor permitted a transversal widening of 7.5 mm within 3 weeks. During the 3-month period of retention, multibanded orthodontic therapy could be performed. DISCUSSION: Because of the short treatment period, absence of recurrence, and easy handling for the patient this method is recommended for clinical use.