Plate Fixation in Neck Surgery: The Way Forward?

Plate fixation has been described to treat some simple displaced vertebral fractures using a ventral or dorsal approach (Nixon 1996, Gygax 2011, Rossignol 2016). Locking compression plate (LCP) or dynamic compression plate (DCP) can be used but LCP are recommended because of their improved biomechanical properties and easier application using the long locking drill guides and self-tapping screws. In case of fractures of the vertebral body involving the disk, cervical fusion can be performed to improve fracture stabilization.

Surgical cervical fusion as treatment of cervical stenotic myelopathy in horses has also been described using LCP as an alternative to the Cloward Bagby Basket (CBB) and the Kerf Cut Cylinder (KCC). An in vitro study (Reardon et al, 2010) concluded that LCP devices had superior biomechanical properties compared with KCC. One clinical report described successful ventral application locking compression plate for treatment of cervical stenotic myelopathy in a 3-month-old warmblood foal (Reardon 2011). Another report (Rossignol 2015) describes the use of LCP in 7 adult horses to treat cervical myelopathy with similar results compared to KCC.

Excepted in rare cases where a dorsal approach can be used, a ventral approach of the cervical vertebrae is adopted in the majority of cases. Whatever the purpose of plate fixation (fracture fixation or cervical fusion for treatment of stenotic myelopathy) the surgical approach is similar. The horse is placed in dorsal recumbency under general anaesthesia. We usually use custom made V-shaped blocks to stabilize the neck in a strictly vertical position. These blocks allow placement of the radiographic cassettes. Radiographic guidance is used to identify the involved vertebra and/or intervertebral space and surgical site is confirmed with the help of skin staples.  [...]