Measuring hip outcomes: common scales and checklists

Introduction

Assessing the outcomes of patients following surgical interventions is a challenging task. Traditionally the end results of joint replacement were based on morbidity/mortality rates and operative complications. The modern approach to outcomes following Orthopaedic surgery has shifted from the success or failure of implants towards patient satisfaction and the quality of life achieved. The aim of this paper was to identify and analyse the common scoring systems present in the medical literature for evaluating outcomes after hip interventions.

Methods

A pub-med search was performed using terms ‘scoring system, functional outcomes, hip joint’. Specific limitations and exclusion criteria were used and the reference lists of the articles included in the study were subjected to further analysis for identification of additional relevant papers.

Results

293 articles were identified of which 40 met the inclusion criteria. The outcome measures were divided into: (i) hip specific outcomes, (ii) disease-specific measures and (iii) generic quality of life measures. Based on our analysis, we would recommend a combination of the hip specific Oxford Hip Score (OHS) and the disease specific WOMAC score. The OHS is quick and easy to complete, has a very high response rate and is free from clinician bias. On the other hand, the majority of hip pathology is related to degenerative disease, thus making the WOMAC the most appropriate measure to use. Where comparison between different conditions is required, then an additional generic quality of life (QOL) score, such as EQ5D, that can enable comparisons in cost-effectiveness term can be used.

Conclusion

The ideal outcome measure should be one that is specific for the hip joint, possesses a generic component and takes into consideration co-morbidities and the use of walking aids. Although many validated generic measures exist, additional validation studies, including the OHS, are desirable to evaluate all the hip specific measures of outcome.     

Measuring functional and quality of life outcomes following major head injury: common scales and checklists

Traumatic brain injury (TBI) is a major public health issue, which results in significant mortality and long term disability. The profound impact of TBI is not only felt by the individuals who suffer the injury but also their care-givers and society as a whole. Clinicians and researchers require reliable and valid measures of long term outcome not only to truly quantify the burden of TBI and the scale of functional impairment in survivors, but also to allow early appropriate allocation of rehabilitation supports. In addition, clinical trials which aim to improve outcomes in this devastating condition require high quality measures to accurately assess the impact of the interventions being studied. In this article, we review the properties of an ideal measure of outcome in the TBI population. Then, we describe the key components and performance of the measurement tools most commonly used to quantify outcome in clinical studies in TBI. These measurement tools include: the Glasgow Outcome Scale (GOS) and extended Glasgow Outcome Scale (GOSe); Disability Rating Scale (DRS); Functional Independence Measure (FIM); Functional Assessment Measure (FAM); Functional Status Examination (FSE) and the TBI-specific and generic quality of life measures used in TBI patients (SF-36 and SF-12, WHOQOL-BREF, SIP, EQ-5D, EBIQ, and QOLIBRI).     

Measuring foot and ankle injury outcomes: common scales and checklists

Functional health outcome measures are increasingly being used in both clinica trials and practice as measures of patient health. Whilst outcome measures can be generic, there are a number of foot and ankle specific measures available and in use. These are being used as not only region specific but also disease specific measures of patient function. Unfortunately not all of these outcome measures have been completely validated which leads to challenges in applying the results of outcomes research to specific patients. Continued work however is being done in this area and these challenges provide opportunities for further investigation into the role of functional outcome scores specific to the foot and ankle.     

Measuring shoulder injury function: common scales and checklists

The increasing shift towards patient-centred healthcare has lead to an emergence of patient-reported outcome instruments to quantify functional outcomes in orthopaedic patients. Unfortunately, selecting an instrument for use in a shoulder trauma population is often problematic because most shoulder instruments were initially designed for use with chronic shoulder pathology patients. To ensure an instrument is valid, reliable, and sensitive to clinical changes, it is important to obtain psychometric evidence of its use in the target population.Four commonly used shoulder outcome instruments are reviewed in this paper: American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Constant-Murley shoulder score (CMS); Disabilities of Arm, Shoulder, and Hand (DASH); Oxford Shoulder Score (OSS). Each instrument was reviewed for floor or ceiling effects, validity, reliability, responsiveness, and interpretability. Additionally, evidence of each instrument's psychometric properties was sought in shoulder fracture populations.Based on the current literature, each instrument has limited amounts of evidence to support their use in shoulder trauma populations. Overall, psychometric evaluations in isolated shoulder fracture populations remain scarce, and clinicians must remember that an instrument's properties are defined for the population tested and not the instrument. Therefore, caution must always be exercised when using an instrument that has not been fully evaluated in trauma populations.     

Measuring wrist and hand function: common scales and checklists

Introduction

A hand and wrist disorder affects a patient's overall well-being and health-status. One concept serves as the foundation for all further consideration: in order to have confidence in your results when assessing patients with wrist and hand limitations, the clinician and researcher must choose standardised patient-oriented instruments that address the primary aims of the study. In this paper, we assess the quality of reviews published on patient oriented instruments in current use for assessing function of the hand and wrist joint. We highlight features of commonly used scales that improve readers’ confidence in the choice and application of these outcome instruments.

Methods

A literature search (1950-January 2010) was performed using the MESH terms: hand (strength, injuries, joints) and wrist (injuries, joint) combined with outcome and process assessment (questionnaires, outcome assessment, health status indicators, quality of life). Titles and abstracts (n = 341) were screened by two reviewers independently. The GRADE approach was used to assess the quality of ten reviews and the inclusion of clinimetric properties were assessed using the COSMIN checklist.

Results

We included three systematic reviews rated moderate to high (2 hand injury instrument reviews and 1 wrist fracture outcome review). Recommendations of use and an overview are provided for the disability of the arm, shoulder and hand questionnaire (DASH), QuickDASH, the Michigan hand questionnaire (MHQ), the patient-rated wrist hand evaluation outcome questionnaire (PRWHE) and the carpal tunnel questionnaire (CTQ) scales with established measurement properties.

Conclusions

The DASH, a region-specific 30-item questionnaire is the most widely tested instrument in patients with wrist and hand injuries. The MHQ can provide good value to patients with hand injuries. Although, the CTQ is the most sensitive to clinical change, the DASH and MHQ have shown to be sufficiently responsive to outcome studies of carpal tunnel syndrome. The PRWHE has a good construct validity and responsiveness, which is only slightly better than the DASH to assess patients with wrist injuries. As the quality of patient-oriented validation continues to increase then the instruments can be selected more carefully. We will then be able to see that the future orthopaedic care of patients with hand and wrist injuries may also improve.     

Measuring depression and PTSD after trauma: common scales and checklists

Traumatic injury is an important public health problem secondary to high levels of morbidity and mortality. Injured survivors face several physical, emotional, and financial repercussions that can significantly impact their lives as well as their family. Depression and posttraumatic stress disorder (PTSD) are the most common psychiatric sequelae associated with traumatic injury. Factors affecting the prevalence of these psychiatric symptoms include: concomitant TBI, the timing of assessment of depression and PTSD, the type of injury, premorbid, sociodemographic, and cultural factors, and co-morbid medical conditions and medication side effects. The appropriate assessment of depression and PTSD is critical to an understanding of the potential consequences of these disorders as well as the development of appropriate behavioural and pharmacological treatments. The reliability and validity of screening instruments and structured clinical interviews used to assess depression and PTSD must be considered. Common self-report instruments and structured clinical interviews used to assess depression and PTSD and their reliability and validity are described. Future changes in diagnostic criteria for depression and PTSD and recent initiatives by the National Institute of Health regarding patient-reported outcomes may result in new methods of assessing these psychiatric sequelae of traumatic injury.     

Desmoplastic fibroma of the spine: a series of 12 cases and outcomes

Background contextDesmoplastic fibroma (DF) is a benign, yet locally aggressive, tumor of the connective tissue. Desmoplastic fibroma in the spine is extremely rare, and only a few cases have been reported. Although surgical resection of DF arising in the spine is commonly regarded as a recommended treatment, it is difficult to achieve satisfactory results.PurposeThis study reviews the clinical patterns and follow-up data of patients with DF in the spine who underwent surgical treatment. We attempted to correlate surgical treatment and outcomes over time.Study designA retrospective clinical study of the surgical managements, including subtotal resection, total spondylectomy, and en bloc resection, for DF in the spine. Desmoplastic fibroma of the spine treatment occurred from 2004 to 2009 at the Department of Bone Tumor Surgery, AA Hospital.Patient sampleTwelve consecutive cases of DF of the spine underwent surgical treatment at our center between 2004 and 2009.Outcome measuresNeurologic outcomes were evaluated using Frankel score system and recurrence and metastasis were evaluated by computed tomography or magnetic resonance imaging of the surgical segments involved. Imaging was performed 3, 6, and 12 months after surgery, every 6 months for the next 2 years, and then annually for life.MethodsOverall, two different surgery protocols were applied. One protocol involved subtotal resection followed by radiotherapy (n=4), whereas the other involved total tumor resection (n=8). Postoperative radiotherapy was administered in six cases. Clinical data and surgery efficacy were analyzed via chart review.ResultsEleven patients were disease-free during their follow-up period, whereas one patient experienced recurrence without metastasis. Radicular pain nearly disappeared, and patients suffering from spinal cord compression recovered well. Local recurrence was detected in one-fourth (25%) of the cases that underwent subtotal resection and was not detected in any of the cases involving total spondylectomy.ConclusionsLocal recurrence of DF is not uncommon after insufficient removal. Therefore, total excision, while also preserving neural function, is recommended. In our study, patients who underwent a total spondylectomy had significantly lower local recurrence rates for DF in the spine. Radiotherapy may be an acceptable alternative therapy, whereas en bloc resection has the potential to result in significant functional impairment.     

胸腰段脊柱骨折手术治疗的选择策略

近年来,随着高处坠落伤及交通伤的不断增加,胸腰段脊柱骨折呈明显上升的趋势,常因伴有脊髓损伤,早期治疗延误、不当或效果不理想等引起畸形、慢性疼痛及神经功能障碍等。本文就2000年1月-2004年12月手术治疗的54例胸腰段脊柱骨折患者进行了总结,对前后路手术及重建胸腰段脊柱稳     

Metabolic syndrome and hip fracture: Epidemiology and perioperative outcomes

IntroductionHip fractures and metabolic syndrome (MetS) are becoming major global healthcare burdens as populations age. This study sought to determine the impact of MetS in hip fracture patients on perioperative outcomes following operative fixation or arthroplasty.MethodsData from the 2004–2014 Nationwide Inpatient Sample was used to select 3,348,207 discharges with hip fracture. MetS patients were identified by having at least 3 of 4 component comorbidities: hypertension, dyslipidemia, obesity, and diabetes. Logistic regression was used to estimate odds ratios for the association between MetS and perioperative outcomes adjusted for age, gender, race, payer status, and comorbidities.ResultsOverall, 32% of hip fracture patients were treated with open reduction internal fixation (ORIF), 28% hemiarthroplasty (HA), 18% closed reduction with internal fixation (CRPP), and 3% primary total hip arthroplasty (THA). The remaining 19% of cases were either treated via unspecified procedure of hip repair (9%), managed non-operatively (2%), underwent multiple procedures during the hospital stay (6%), or the surgical procedure data was missing (2%) and were excluded from procedural analyses. The prevalence of MetS was 7.9% and increased among minorities, patients treated at urban hospitals, with comorbidities (heart failure, kidney disease, peripheral vascular disease), and with Medicare coverage. MetS was associated with increased odds of any adverse event (p < 0.0001), specifically: acute renal failure, myocardial infarction, acute posthemorrhagic anemia. MetS was also associated with increased LOS (p < 0.0001) and increased total charges (p < 0.0001). However, MetS was associated with reduced odds of postoperative pneumonia, deep vein thrombosis and pulmonary embolism, surgical site infection, septicemia, and in-hospital mortality (p < 0.0001). The above associations were maintained for MetS patients stratified according to their treatment groups: HA, CRPP, and ORIF.ConclusionsMetS is associated with increased odds of complications in hip fracture patients but decreased odds of in-hospital mortality. This may be related to patients’ nutritional status and catabolic states in the perioperative period.     

脊柱骨盆骨折合并腹部闭合伤的早期诊断

目的 探讨脊柱骨盆骨折合并腹部闭合损伤的诊断方法,提高其诊断水平。方法 回顾分析１９８０￣１９９８年本院收治的８４例脊柱骨盆骨折合并腹部闭合损伤病人的临床资料,对比各种诊断方法与手术结果。结果 腹腔穿刺阳性率８２％,ＣＴ阳性率７４％,Ｂ超阳性率７０％。１２ｈ内手术病死率９．８％,７２ｈ后手术病死率３６％。结论 脊柱骨盆骨折合并腹部闭合损伤易发生误诊,漏诊。其病死率与手术时机有明显关系,腹腕穿刺是一     

Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries

BACKGROUND/OBJECTIVE: Recent studies have reported on the outcomes of spinal cord injuries in the elderly. Our aim was to identify acute survival differences between elderly patients with atlantoaxial injuries relative to subaxial injuries at our institution and to determine whether operative treatment is associated with improved survival rates in either population. STUDY DESIGN: Retrospective database review of all traumatic cervical spine injuries in patients at least 65 years of age at a single tertiary care center. METHODS: A total of 193 consecutive patients at least 65 years of age treated at a single tertiary care center over a 12-year period were identified. Initial hospitalization records were reviewed. Patients were divided by anatomic level of injury: atlantoaxial (C1 or C2) and subaxial (C3 or below). Demographics, mechanism, and mortality rates were compared. Each group was further divided by treatment (operative or nonoperative), and inpatient survival rates were compared. RESULTS: Statistically similar survival rates were observed among patients with atlantoaxial and subaxial injuries (P = 0.10). Patients with nonoperatively treated subaxial injuries died at significantly higher rates than did their operatively treated peers (P < 0.05). CONCLUSIONS: In this large comprehensive series of elderly patients with cervical spine injuries, survival rates were comparable regardless of anatomic level of injury. The operative treatment of subaxial injuries was associated with an improved acute survival rate vs nonoperative management. Further prospective study is needed to better assess this relationship.     

Enhanced prediction of fracture risk combining vertebral fracture status and BMD

Summary Prevalent vertebral fractures are associated with increased fracture risk, but the magnitude of this effect across a range of BMD T-scores has not been quantified. In this analysis, for any given BMD T-score, incident fracture risk varied up to twelve fold when information regarding prevalent radiographic vertebral fracture status was considered. Background Clinical fracture risk evaluation of older women usually includes assessment of bone mineral density (BMD) but often not vertebral fracture status. In this analysis, we quantified the impact of vertebral fracture burden on two year fracture risk across a range of BMD T-scores. Methods Data were from 2,651 postmenopausal women who were assigned to the placebo groups of the Fracture Prevention Trial (median observation 21 months) and the Multiple Outcomes of Raloxifene Evaluation Trial (MORE; observation 2 years). Using the Genant visual semiquantitative criteria, we defined prevalent vertebral fracture status as: a) presence or absence of fracture; b) fracture number; c) maximum semi-quantitative (SQ) score (normal=0, mild fracture=1, moderate fracture=2, severe fracture=3); and d) spinal deformity index (SDI) score (sum of SQ scores of T4 to L4 vertebrae). Incident fractures over two years were identified via lateral spine radiographs and outside the spine by questioning of patients and review of radiographs or radiographic reports. Results Femoral neck BMD T-score provided significant information regarding fracture risk. Across the range of T-scores, vertebral fracture status provided additional prognostic information. The risk increased with increasing number and severity of prevalent vertebral fractures and SDI, a summary measure of spine fracture burden. Across a range of BMD values, prevalent spine fracture burden as assessed by SDI increased the risk of incident vertebral fractures by up to 12-fold, nonvertebral fractures by about twofold, and any fractures by up to sevenfold. Conclusions These findings indicate that at any given BMD T-score, the risk of incident vertebral, non-vertebral, and any fracture depended heavily on prevalent radiographic vertebral fracture status. Assessment of vertebral fracture status, in addition to BMD, provides practical and relevant clinical information to aid in predicting fracture risk in postmenopausal women. This study was supported by Eli Lilly and Company.     

Measuring patient outcomes: a primer

When designing a study, it is important to select appropriate instruments to measure health outcomes. An investigator must have a comprehensive understanding of the disease and its effects on patient health to inform instrument selection. We provide a brief introduction of different ways that health is defined and the properties of a good measurement tool (reliability, validity, sensitivity to change). We describe patient-reported outcomes (PROs) and methods to improve their interpretability, and we include strategies to reduce bias in health measurement and considerations that may improve the feasibility of measuring outcomes in a research study.     

Twelve-month mortality and functional outcomes in hip fracture patients under 65 years of age

IntroductionThere has been a recent call for improved functional outcome reporting in younger hip fracture patients. Younger hip fracture patients represent a different population with different functional goals to their older counterparts. Therefore, previous research on mortality and functional outcomes in hip fracture patients may not be generalisable to the younger population. The aims of this study were to report 12-month survival and functional outcomes in hip fracture patients aged <65 years and predictors of functional outcome.MethodsHip fracture patients aged <65 years (range 17–64) registered by the Victorian Orthopaedic Trauma Outcomes Registry over four years were included and their 12-month survival and functional outcomes (Extended Glasgow Outcome Scale) reported. Ordered multivariable logistic regression was used to identify predictors of higher function.ResultsThere were 507 patients enrolled in the study and of the 447 patients (88%) with 12-month outcomes, 24 (5%) had died. The majority of patients had no comorbidities or pre-injury disability and were injured via road trauma or low falls. 40% of patients sustained additional injuries to their hip fracture. 23% of patients had fully recovered at 12 months and 39% reported ongoing moderate disability. After adjusting for all key variables, odds of better function 12-months post-fracture were reduced for patients with co-morbidities, previous disability or additional injuries, those receiving compensation or injured via low falls.ConclusionsWhile 12-month survival rates were satisfactory in hip fracture patients aged under 65 years, their functional outcomes were poor, with less than one quarter having fully recovered 12 months following injury. This study provides new information about which patients may have difficulty returning to their pre-injury level of function. These patients may require additional or more intensive post-discharge care in order to fulfil their functional goals and continue to contribute productively to society.     

两种人工骨椎体成形术在胸腰椎骨折治疗中的近期疗效

目的前瞻性地研究两种不同方法的椎体成形术在胸腰椎骨折治疗中的疗效比较。方法自2002年以来,我科共收治128例胸腰椎骨折患者,按AO分型均为A型。随机分成两组:A组64例,在后路椎弓根螺钉复位内固定的基础上应用注射型人工骨进行椎体成形,术前矢状面指数(SI)平均为34°;B组64例,在后路椎弓根螺钉复位内固定的基础上应用固态人工骨进行椎体成形,SI平均为36°。结果所有患者平均随访18.5个月,A组术后即刻SI平均为13°,椎体终板高度丢失平均为4.0mm,在最后随访时SI和终板高度丢失无明显变化;B组术后即刻SI平均为4.5°,椎体终板高度丢失平均为1.0mm,在最后随访时SI和终板高度丢失无明显变化。A组与B组之间术前SI差异无显著性意义(P>0.05);术后即刻及最后随访时SI差异均有极显著性意义(P<0.01),术后即刻及最后随访时终板高度丢失差异均有极显著性意义(P<0.01)。结论胸腰椎骨折行后路复位内固定时,进行椎体成形不仅能够有效地填充椎体内骨缺损空腔,避免术后复位效果的丢失,而且用固态人工骨进行椎体成形,能改善椎体终板塌陷的复位效果,也比注射型人工骨更安全,不会渗漏至椎管内造成严重的并发症。术后长期疗效仍有待进一步随访研究。     

手术治疗的桡骨远端骨折预后指标间相关性分析

目的分析采用手术治疗的桡骨远端骨折患者的预后指标的相关性。方法采用多中心回顾性研究,通过病历查询及随访的方式获取资料,记录患者的性别、年龄、满意度、功能及影像学评分等,用SPSS软件进行统计学分析。结果135例获得随访17-49个月,影像学指标与Gartland＆Werley评分存在一定相关性（ROC曲线法：AUC=0．639,P=0．017）。患者主观满意度主要与掌屈、旋前一旋后相关。结论桡骨远端骨折患者的功能预后并不完全由影像学决定。患者满意度主要与关节活动相关,预后需综合多方面的指标。     

Epithelioid hemangioendotheliomas of the spine: clinical characters with middle and long-term follow-up under surgical treatments

Epithelioid hemangioendothelioma, an aggressive vascular tumor has the rarity of morbidity that arises in the spine. There were few cases reported in literatures in recent years, and little was known about this disease. A review study of the patient files in our constitutions between 1996 and 2006 showed that five patients were treated for spinal epithelioid hemangioendothelioma. Although only five patients, this study attempts to bring more informations about this rare lesion. This patient group included two males and three females. The lesions located in the cervical (case 1) or thoracic (case 2–4) or lumbar spine (case 5). Treatments included: laminectomy and cytoreductive surgery followed by external beam irradiation (one patient), expanded resection in piece meal with postoperative external beam irradiation (three patients), and total en bloc resection alone (one patient). Reconstruction of the spinal stability was performed in four patients. Follow-up period ranged from 25 to 72 months, averaged 47.4 months. The neurologic function of patients got a satisfactory progress except the paraplegic patient at diagnosis. The patient who received laminectomy and cytoreductive surgery followed by external beam irradiation still presented with tumor local progress, metastasis, and she died at 34 months after operation. No local recurrence or distant metastasis was detected in the other four patients. Epithelioid hemangioendothelioma of the spine is so rare in clinic as a primary aggressive vascular tumor. Based on our experience, a valid expanded resection of the tumor with adjunct radiation therapy or total en bloc excision may present with acceptable results.     

Management of thoracolumbar spine fractures

Background contextTraumatic fractures of the spine are most common at the thoracolumbar junction and can be a source of great disability.PurposeTo review the most current information regarding the pathophysiology, injury pattern, treatment options, and outcomes.Study designLiterature review.MethodsRelevant articles, textbook chapters, and abstracts covering thoracolumbar spine fractures with and without neurologic deficit from 1960 to the present were reviewed.ResultsThe thoracolumbar spine represents a unique system from a skeletal as well as neurological standpoint. The rigid rib-bearing thoracic spine articulates with the more mobile lumbar spine at the thoracolumbar junction (T10 - L2), the site of most fractures. A complete examination includes a careful neurologic examination of both motor and sensory systems. CT scans best describe bony detail while MRI is most efficient at describing soft tissues and neurological structures. The most recent classification system is that of the new Thoracolumbar Injury Classification and Severity Score. The different fracture types include compression fractures, burst fractures - both stable and unstable -, flexion-distraction injuries and fracture dislocations. Their treatment, both operative and non-operative depends on the degree of bony compromise, neurological involvement, and the integrity of the posterior ligamentous complex. Minimally invasive approaches to the care of thoracolumbar injuries have become more popular, thus, the evidence regarding their efficacy is presented. Finally, the treatment of osteoporotic fractures of the thoracolumbar spine is reviewed, including vertebroplasty and kyphoplasty, their risks and controversies, and senile burst fractures, as well.ConclusionsThoracolumbar spine fractures remain a significant source of potential morbidity. Advances in treatment have minimized the invasiveness of our surgery and in certain stable situations, eliminated it all together.     

Effect of plate position on clinical outcome after anterior cervical spine surgery

BACKGROUND CONTEXT: Anterior cervical plates are commonly used to provide immediate stabilization after a variety of cervical spine procedures. It has been assumed that the ideal position for anterior cervical spine plates is centered in the horizontal plane without significant angulation and without overlap of adjacent unfused levels. Nevertheless, postoperative radiographs often demonstrate actual plate position to be lateralized, rotated, or encroaching on the adjacent disc space. There have been no reported systematic studies examining the effect of variations in plate position in a large clinical population. PURPOSE: To evaluate the association between plate position and short-term clinical outcomes after anterior cervical discectomy and instrumented fusion (ACDF). STUDY DESIGN/SETTING: Review of prospectively collected clinical outcomes measures and radiographs. PATIENT SAMPLE: Patients undergoing ACDF surgery by a group of spine surgical specialists at a single institution. OUTCOME MEASURES: Direct and calculated plain radiographic measurements, visual analog scores for neck and arm pain, and SF-36 scores. METHODS: The study population included 200 patients undergoing a one-, two-, or three-level ACDF with instrumentation. Thirteen separate direct measurements and two calculated values of plate position on immediate postoperative radiographs, including lateralization, rotation, and proximity to adjacent disc spaces, were performed in blinded fashion by 3 independent reviewers. Statistical correlation with prospectively collected patient outcomes measures, including VAS for neck and arm pain and SF-36 scores, was performed. RESULTS: In the study population, average plate position was 3.3 mm from the cephalad disc space, 6.4 mm from the caudal disc space, 3.9 degrees angulation in the frontal plate, and 26% laterally displaced from the midline. At average 18.6 months of follow-up, no significant association was identified between any plate position measure and clinical outcomes. CONCLUSIONS: The use of anterior cervical plating by experienced spine surgeons is associated with variation in terms of plate position on postoperative radiographs. Within the range of positions analyzed in this study, no significant association was found between lateralized or rotated plates or plates placed in proximity to adjacent disc spaces and worse short-term clinical outcomes. It should be emphasized that these results and conclusions are based on relatively short-term clinical follow-up and that the long-term effects of variation in implant position remain unknown.