Comparison of tension band wiring and lateral mass plating for subaxial posterior cervical fusion.

BACKGROUND: Two instrumentation methods for subaxial posterior cervical fusion are compared in terms of efficacy, morbidity, and significant cost-related variables. METHOD: Thirty-four patients with tension band wiring and 14 patients with lateral mass plating are retrospectively compared in a single surgeon's experience between 1989 and early 1995. RESULTS: Both groups were similar in regard to operative indication (about 40% trauma, 30% degenerative changes in each group), postoperative immobilization (hard collar only used in 82% of patients wired and 79% of patients plated), and number of levels fused (mean, 1.7 in each group). Mean follow-up is 23 months for wiring and 35 months for plating. Pseudoarthrodesis occurred in one patient undergoing wiring and in none of the patients plated. Both methods resulted in complications (7 in 34 cases of wiring, 4 in 14 cases of plating), but no patient experienced neurologic decline. Statistically significant differences between the two groups were found for estimated blood loss, operating room time, and hardware cost, but not for postoperative orthosis or length of stay. CONCLUSION: In some instances when subaxial posterior fusion is performed, tension band wiring may be more cost-efficient. Tension band wiring and lateral mass plating seem to have comparable efficacy and morbidity, but the indications for each technique differ.