Product details

The CODA™ ACP System consists of single-use titanium alloy (Ti-6Al-4V ELI) plates and screws that are available in both sterile and nonsterile sets. The plates are offered in various lengths and are low profile with a height of 1.9 mm (one- to three-level plates) and 2.1 mm (four- to five-level plates). The plates have bone grafting windows that allow optimal visualization of the graft, vertebral bodies, and endplates. The plates have an integrated active locking mechanism and can accommodate constrained angle and variable angle screws. The system includes nonsterile reusable instruments and sterile single-use instruments, designed to facilitate proper implantation of the plate and screws.

Plates

The CODA™ ACP System plates are available in these lengths (Fig 3):

• One level (lengths: 10–30 mm, increments of 2 mm)
• Two levels (lengths: 24–44 mm, increments of 2 mm)
• Three levels (lengths: 42–66 mm, increments of 3 mm)
• Four levels (lengths: 60–88 mm, increments of 4 mm)
• Five levels (lengths: 75–105 mm, increments of 5 mm)

The plate profile is 1.9 mm in 1–3-level plates, and 2.1 mm in 4–5-level plates. The screw locking mechanism is flush to the plate. The plate width is 17 mm at the widest point and 13 mm at the waist.

Instruments

Instruments included in the CODA™ ACP System include drivers (threaded and tapered), temporary pins for fixation (push pins and threaded pins), templates, plate bender, awl, drills, taps, and screw guides (Fig 5 and Fig 6).

Case 1: 46-year-old man with Central Cord Syndrome following a fall down stairs

A 46-year-old man presented for evaluation of the cervical spine with magnetic resonance imaging (MRI) evidence of C4/5 mild retrolisthesis with central cord compression.

Initial injury: February 8, 2024
The patient tripped and fell down three stairs on February 8, 2024, landing face-first onto a cement floor. He was noted to have deficits to all limbs at the time of injury, with decreased grip strength. He denied neck or back pain. Magnetic resonance imaging and CT scans were performed, demonstrating C4/5 retrolisthesis, and no acute fractures but evidence of central stenosis at C4/5. The patient was offered surgery at the time of initial hospital admission but declined so that he could return to family in the US.

Assessment at spine clinic: February 26, 2024
The same patient presented at the spine clinic for evaluation of the cervical spine. The chief complaint was of bilateral upper extremity weakness and hyperesthesia affecting shoulder to fingers bilaterally. The patient reported dexterity problems in his hands and the inability to hold small objects, such as a pen. He also reported pain radiating bilaterally from elbow to fingers. The patient was not engaged in formal physical therapy. Without medication, the patient reported pain of 6/10. No relevant past medical or surgical history was reported.

Physical examination of the upper extremities showed bilateral muscle weakness (elbow, wrist, and hand), and areas of hyperesthesia on the left side.

Imaging was conducted. Plain x-rays (Fig 7) showed:

• No acute fracture
• Evidence of degenerative disc disease at levels C5/6 with focal disc height loss.

Magnetic resonance imaging of the cervical spine performed at the time of injury (Fig 8) was reviewed and showed:

• Spinal canal narrowing at C4/5 with cord compression and associated cord edema
• Bilateral uncovertebral osteophytes with mild bilateral foraminal narrowing
• C5/6 with mild posterior disc bulging causing mild canal narrowing without cord compression
• Mild bilateral foraminal narrowing of C6/7.

A diagnosis was made of cervical spinal stenosis largely attributable to stenosis at C4/5, with lesser stenosis at C5/6 and cord compression causing sub-acute central cord syndrome. Anterior decompression was recommended to alleviate symptoms, and C4/5 anterior cervical discectomy and fusion (ACDF) was performed on March 7, 2024. Fig 9 shows postoperative imaging.

Case 2: 34-year-old man injured following fall from 10-m height

A 34-year-old man with a history of alcohol use disorder and prior seizures was admitted to hospital after being found outside his house having reportedly fallen from a second-story window. The patient had numbness and left-sided deficits, did not recall the circumstances of the fall, and was very intoxicated in the emergency department.

Full-spine imaging (Fig 10) showed injuries including a C6 flexion distraction with significant burst fracture (AO C6 B2 A4) with retropulsion into the canal and associated kyphosis, with an associated mildly displaced C6 spinous process fracture, C7 displaced spinous process fracture, occipital condyle fractures without extension into the facets, and transverse process fractures of T11, L1, L2, L3, and L4.

Other injuries included fractures of ribs 10–12 on the left side, left pneumothorax and lung contusion, left vertebral artery occlusion, and hemorrhagic contusions of frontal lobes and temporal lobes.

Physical examination showed muscle weakness in the left upper extremity, especially in the hand, and reduced sensation in the left upper extremity (C5–T1). The lower extremities had normal muscle strength and sensation.

The patient underwent a C6 corpectomy with removal of fractured C6 vertebral body, restoration of height and placement of a Synmesh cage filled with autograft from the fracture. Following restoration of height and vertebral body reconstruction, a CODA™ ACP plate was applied anteriorly with screws into the C5 and C7 vertebral bodies. Given the psychosocial nature of the patient and the fracture pattern, the patient was then placed prone and underwent posterior instrumentation with Symphony instrumentation with lateral mass screws into C5 and C6 bilaterally and pedicle screws into C7 followed by placement of 4 mm rods along with fusion (Fig 11).

The patient did well postsurgery (Fig 12) and was discharged according to protocol, but was unfortunately then lost to follow-up.