Plate fixation

Compression fractures of the vertebral body are most frequently diagnosed associated with articular process fractures.

Fractures of the vertebral body can be stabilized with plates. The goal of surgery is to provide decompression at the fracture site by realigning the fragment with the vertebral body and providing stability with some form of fixation.

If more than one vertebra is affected, intervertebral fusion is attempted during the fixation of the fracture.

This procedure is performed with the patient positioned in dorsal recumbency through the ventral midline approach to the cervical spine.

The fracture is reduced by manipulation using pointed reduction forceps and strong digital pressure.

Either (a) locking compression plate (LCP) or (b) dynamic compression plate (DCP) is used for fracture fixation of the vertebrae. According to the size of the patient, a small or broad 3.5-4.5mm DCP or a 3.5/4.0 or 4.5/5.0mm LCP is used.

Pearl: Advantages of the LCP over the DCP:

• The plate does not have to be accurately contoured to the bone surface; therefore less bone from the ventral spine needs to be removed in preparation for plate application.
• Locking the screws to the plate provides a more stable fixation.

Minimal plate contouring is needed.

With the reduction forceps in position, the appropriately sized plate is applied to the ventral aspect of the vertebra. The plate should be as long as possible to achieve better stabilization.

Intraoperative radiographic control of the drilling depth and screw positioning is critical to prevent penetration of the vertebral canal.

The image shows intraoperative radiographic control of the drilling depth and screw positioning.

Note: Penetration of the spinal canal with the drill must be avoided.

Intraoperative image showing penetration of the spinal canal.

Cortex screws are used in lag fashion at the level of the fracture to compress the fragments. The correct length of the screws is determined with the help of fluoroscopy.

Note: Attention must be paid not to damage the spinal cord.

The remaining holes are filled with locking-head screws.

If the fracture expands over two vertebrae, the fusion of these two vertebrae and possibly also the next caudal one is attempted.

The ventral spinous process of the body of the affected vertebrae is flattened slightly using a curved osteotome and bone rongeur.

The disc material has to be removed, at least partially, with multiple parallel drill holes with a 5.5mm drill bit under radiographic guidance.

The fracture is reduced by manipulation using pointed reduction forceps and strong digital pressure.

If the fracture expands over two vertebrae, cortex screws are used in lag fashion at the level of the fracture in both fragments.

The remaining holes are filled with locking screws.

The muscles, subcutaneous tissue, and the skin were closed in a continuous fashion. A close active drain can be placed at the level of the plate, exiting the skin near the incision and sutured to the skin.

A stent bandage is applied, and covered with an adhesive barrier drape to keep the incision clean and dry during recovery.

Following surgery, antibiotics and NSAIDs are routinely administered for 3 days. If indicated, they need to be continued.

Routinely follow up radiographs are taken immediately after surgery and after 2 and 4 months.

The rehabilitation protocol includes 2 months of stall confinement, followed by 1 month of hand-walking, and 2 months of progressive exercise.

Only when the ataxia has completely disappeared, the horse can return to training or other activities.

There is no need for implant removal, except in cases of implant loosening or surgical site infection.