What pitfalls are associated with the use of anterior cervical plates in conjunction with multilevel corpectomies

Multilevel corpectomy constructs stabilized by anterior plates without use of supplemental posterior fixation are at high risk of failure due to:

1. Screw pullout at the inferior segment

2. Subsidence of the strut graft or cage into the vertebral body receptor sites

3. Graft or cage dislodgement

4. Pseudarthrosis

Biomechanical studies have shown that excessive forces occur at the caudal vertebral body screws. In multiple-level corpectomy constructs, subsidence from 1 to 3 mm at each level results in increased screw contact forces caudally. Resultant loss of fixation can lead to graft dislodgement with catastrophic failure of the construct. Additionally, graft resorption commonly occurs at the proximal and distal extent of the graft, where it contacts the vertebral body. If the construct is splinted by a plate, nonunion may result. For these reasons, anterior decompression and fusion combined with posterior spinal instrumentation (typically a screw-rod system) are recommended when multilevel cervical corpectomy procedures are performed—specifically, all three-level corpectomies and certain two-level corpectomies.

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