Anterior Column of the Spine
There are a variety of approaches and techniques that spinal surgeons use to treat spinal trauma, deformity and tumors. Traditionally, the most common approach to the spine is from the back of the patient, which provides direct access to the posterior column of the spine. Posterior spinal instrumentation used for correction or stabilization of spinal problems can be attached to the posterior elements of the vertebrae or placed through the pedicles of the vertebral bodies with this approach. However, a surgical approach through the abdomen to the anterior part of the spine often provides the best visualization and opportunity to treat certain fractures, deformities, and tumors.

Historically, the modern era of anterior spinal surgery was ushered in by the pioneering work of Dr. AR Hodgson in the treatment of Pott's disease of the cervical, thoracic, and lumbar spine. This advance was stimulated by his quest for greater visibility and direct operative access to spinal abscesses from tuberculosis. In the word of Dr. Hodgson:

"We were dissatisfied with the exposure afforded by costotransversectomy as we found the operation difficult and the field restricted. We have felt that the obvious place to fuse the spine would be anteriorly where there is the largest portion of bone and where the graft would be in compression with adequate protection. It should hypertrophy according to Wolffs' Law and fulfill Percival Pott's criterion of healing, that fusion of the bodies of the vertebrae 'was the thing aimed at'." (AR Hodgson and FE Stock, Anterior Spinal Fusion: A preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. British Journal of Surgery. XLIV: 266, 1956.)

With the success of an anterior approach to the spine for the treatment of infectious conditions, attention turned to the operative correction of scoliotic deformities via anterior approaches. Most often, a compression device consisting of screws placed into the vertebral body and connected via a threaded rod or cable was used to reduce to convexity of a scoliotic deformity. These procedures afforded excellent visualization of the deformity and also allowed surgeons to attempt to correct and fuse the fewest number of misaligned vertebral segments, which preserves as many normal vertebral levels as possible. Unfortunately, early designs of anterior instrumentation were inadequate and unable to withstand many of the stresses that were placed upon them, and they often failed in clinical usage.

As the science and technology behind spinal surgery and instrumentation has progressed, spine implants have become significantly stronger, more reliable, easier to use, and less prone to failure. The continuing development of anterior instrumentation by medical device manufacturers has given spinal surgeons a powerful and versatile tool for the correction and fixation of misalignment and instability of the spinal column. Modern anterior instrumentation offers several advantages; it allows for placement of fixation at each vertebral level, allows for correction of deformity in both the coronal (frontal) plane and the saggital (lateral) plane, and the instrumentation provides structural support where the forces carried on the spinal column are the greatest. Also, access to the anterior column of the spine allows the surgeon to place bone graft in the intervertebral spaces where the fusion of the spine will be the most effective.

Technology First
The shortcomings of the early designs of anterior spinal instrumentation are now a thing of the past, and advances in the design and manufacturing of instrumentation systems have increased the ease of application, and a greater variety of implant sizes has increased the versatility of the anterior approach. With these developments, spine surgeons are able to instrument the anterior column of the spine after the surgical correction of spinal deformity and fractures with ever increasing confidence.

The CD HORIZON® ANTARES™ Spinal System represent a new addition to the CD HORIZON® Spinal System. The CD HORIZON® ANTARES™ Spinal System is based around a new, anatomically designed "pringle shaped" staple that allows for the placement of two screws at each vertebral level.

These screws are then connected along the anterior column by dual rods and stabilized by a Low Profile CROSSLINK® System that produces a very strong surgical construct. The system uses the CD HORIZON® M8 fixed angle screws, which have a low profile, are easy to assemble, and are well known to most spinal surgeons. A specially modified, top loading, one-piece cross-link plate has been designed so that it can be applied to dual rods and secured with two top-tightening nuts that have eliminated much of the "fiddle-factor" involved in placing cross-links. The simplicity of design of the CD HORIZON® ANTARES™ Spinal System increases the ease of placement, while the small size and low profile of the system allows for excellent visualization of the surgical anatomy during placement and correction of deformity.