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Anterior cervical locking plate-related complications; prevention and treatment recommendations

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A retrospective study evaluating complications in 2,233 consecutive patients of subaxial cervical disorders treated with an anterior cervical locking plate was performed, and recommendations for prevention and treatment were made. The average length of follow-up was 1.3 years. Any loosening or breaking of the plates and screws or malpositions that threatened tracheoesophageal or neurovascular structures were defined as the complications. There were 239 cases (10.7%) with different kinds of complications. The complications included oblique plating in 56 cases in which the screw could irritate the nerve root. Screws were driven into the disc space in four cases, which ultimately led to plate loosening. Screws penetrated the endplate or passed excessively close to it producing a triangle fracture in 19 cases. Loosening or breaking of the plate and the screw was found in 115 cases. These phenomena were always associated with non-union. Three oesophageal perforations occurred and conservative treatments proved effective. Finally, overlong plates impinged on the adjacent level in 14 cases and promoted disc degeneration ultimately leading to revision surgery. Good training and careful operation may help to decrease the complication rate. Most hardware complications are not symptomatic and can be treated conservatively. Only a few of them need immediate reoperation.


Nous avons réalisé une étude rétrospective de 2,233 patients consécutifs, traités par plaques cervicales verrouillées pour divers problèmes cervicaux. Le suivi moyen a été de 1.3 ans. Nous n’avons observé aucun démontage ni aucune fracture de matériel. Les malpositions de la plaque avec des lésions trachéo oesophagiennes ou neurovasculaires ont été répertoriées comme complications. Celles-ci ont été au nombre de 239 (10.7%), notamment une malposition de plaque implantée obliquement avec une irritation des racines nerveuses. Les vis étaient dans l’espace inter discal dans 4 cas avec un démontage dans les suites. Les anomalies au niveau de la plaque ont été retrouvées dans 115 cas. Celles-ci sont toujours associées à une pseudarthrose. Nous avons observé trois perforations de l’œsophage qui ont été traitées de façon conservatoire. Un conflit avec la plaque ou une dégénération discale du disque adjacent est survenu 14 fois. Avec la courbe d’apprentissage, les résultats devraient s’améliorer et le taux de complication diminuer. La plupart des complications dues au matériel n’ont pas entraîné de symptômes et n’ont pas été traitées.

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Correspondence to Yuan Wen.

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Ning, X., Wen, Y., Xiao-Jian, Y. et al. Anterior cervical locking plate-related complications; prevention and treatment recommendations. International Orthopaedics (SICO 32, 649–655 (2008).

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