Skip to main content

Advertisement

SpringerLink
Log in

Expandable titanium cages for anterior column cervical reconstruction and their effect on sagittal profile: a review of 48 cases

  • Clinical Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Expandable cervical cages have been utilised successfully to reconstruct the cervical spine for various conditions. However, to date there are only limited data on their influence on cervical sagittal profile. In this retrospective study, we present our experience with performing anterior cervical corpectomy in one or two levels using expandable titanium cages in order to achieve stable reconstruction and restoration of cervical lordosis.

Methods

A case series of data from 48 consecutive patients (20 men, 28 women; mean age 61 years) operated upon in a 5-year-period is retrospectively reviewed. Standard anterior single- or two-level cervical corpectomy, fusion and spinal reconstruction were performed, including placement of an expandable titanium cage and an anterior cervical plate. The mean follow-up was 23 months (range, 8–42 months). Outcome was measured by clinical examinations and visual analogue scale (VAS) scale; myelopathy was classified according the Nurick grading system. Radiographic analysis comprised several parameters, including segmental Cobb angle, cervical lordosis, subsidence ratio and sagittal cage angle. Computed tomography was done 1 and 2 years after surgery; cervical spine radiographs were obtained 3, 6, 12 and 24 months after surgery.

Results

In 38 patients (79 %) osseous fusion or stability of construct could be demonstrated in the 2-year follow up examination. The mean restoration of segmental Cobb angle as well as cervical lordosis amounted to 7.6° and 5.4° respectively, both being statistically significant. Furthermore, a profound correction (10° or more) of the sagittal cervical curve was shown in 15 patients.

Conclusion

Regarding the restoration of the physiological sagittal cervical profile, expandable cervical cages seem to be efficient and easy to use for cervical spine reconstruction after anterior corpectomy. Donor-site-related complications are avoided, fast and strong reconstruction of the anterior column is provided, resulting in satisfactory fusion rates after 2 years.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Arts MP, Peul WC (2008) Vertebral body replacement systems with expandable cages in the treatment of various spinal pathologies: a prospectively followed case series of 60 patients. Neurosurgery 63:537–544, discussion 544–535

    Article  PubMed  Google Scholar 

  2. Auguste KI, Chin C, Acosta FL, Ames CP (2006) Expandable cylindrical cages in the cervical spine: a review of 22 cases. J Neurosurg Spine 4:285–291

    Article  PubMed  Google Scholar 

  3. Barnes B, Haid RW, Rodts GE, Subach BR, Kaiser M (2002) Early results using the Atlantis anterior cervical plate system. Neurosurg Focus 12:E13

    Article  PubMed  Google Scholar 

  4. Bishop RC, Moore KA, Hadley MN (1996) Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:206–210

    Article  PubMed  CAS  Google Scholar 

  5. Brown JA, Havel P, Ebraheim N, Greenblatt SH, Jackson WT (1988) Cervical stabilization by plate and bone fusion. Spine (Phila Pa 1976) 13:236–240

    Article  CAS  Google Scholar 

  6. Burkett CJ, Baaj AA, Dakwar E, Uribe JS (2012) Use of titanium expandable vertebral cages in cervical corpectomy. J Clin Neurosci 19:402–405

    Article  PubMed  Google Scholar 

  7. Buttermann GR, Glazer PA, Bradford DS (1996) The use of bone allografts in the spine. Clin Orthop Relat Res :75–85

  8. Cabraja M, Abbushi A, Koeppen D, Kroppenstedt S, Woiciechowsky C (2010) Comparison between anterior and posterior decompression with instrumentation for cervical spondylotic myelopathy: sagittal alignment and clinical outcome. Neurosurg Focus 28:E15

    Article  PubMed  Google Scholar 

  9. Chibbaro S, Benvenuti L, Carnesecchi S, Marsella M, Pulera F, Serino D, Gagliardi R (2006) Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci 13:233–238

    Article  PubMed  CAS  Google Scholar 

  10. Das K, Couldwell WT, Sava G, Taddonio RF (2001) Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg 94:174–178

    PubMed  CAS  Google Scholar 

  11. Eleraky MA, Llanos C, Sonntag VK (1999) Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg 90:35–41

    Article  PubMed  CAS  Google Scholar 

  12. Hee HT, Majd ME, Holt RT, Whitecloud TS 3rd, Pienkowski D (2003) Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 16:1–8, discussion 8–9

    Article  PubMed  Google Scholar 

  13. Kandziora F, Pflugmacher R, Schaefer J, Scholz M, Ludwig K, Schleicher P, Haas NP (2003) Biomechanical comparison of expandable cages for vertebral body replacement in the cervical spine. J Neurosurg 99:91–97

    PubMed  Google Scholar 

  14. Kotil K, Tari R (2011) Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up. Turk Neurosurg 21:606–612

    PubMed  Google Scholar 

  15. Mayr MT, Subach BR, Comey CH, Rodts GE, Haid RW Jr (2002) Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 96:10–16

    PubMed  Google Scholar 

  16. Narotam PK, Pauley SM, McGinn GJ (2003) Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 99:172–180

    PubMed  Google Scholar 

  17. Nassr A, Khan MH, Ali MH, Espiritu MT, Hanks SE, Lee JY, Donaldson WF, Kang JD (2009) Donor-site complications of autogenous nonvascularized fibula strut graft harvest for anterior cervical corpectomy and fusion surgery: experience with 163 consecutive cases. Spine J 9:893–898

    Article  PubMed  Google Scholar 

  18. Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100

    Article  PubMed  CAS  Google Scholar 

  19. Omeis I, Bekelis K, Gregory A, McGirt M, Sciubba D, Bydon A, Wolinsky JP, Gokaslan Z, Witham T (2010) The use of expandable cages in patients undergoing multilevel corpectomies for metastatic tumors in the cervical spine. Orthopedics 33:87–92

    Article  PubMed  Google Scholar 

  20. Ordway NR, Rim BC, Tan R, Hickman R, Fayyazi AH (2012) Anterior cervical interbody constructs: effect of a repetitive compressive force on the endplate. J Orthop Res 30:587–592

    Article  PubMed  Google Scholar 

  21. Porter RW, Crawford NR, Chamberlain RH, Park SC, Detwiler PW, Apostolides PJ, Sonntag VK (2003) Biomechanical analysis of multilevel cervical corpectomy and plate constructs. J Neurosurg 99:98–103

    PubMed  Google Scholar 

  22. Rajshekhar V, Arunkumar MJ, Kumar SS (2003) Changes in cervical spine curvature after uninstrumented one- and two-level corpectomy in patients with spondylotic myelopathy. Neurosurgery 52:799–804, discussion 804–795

    Article  PubMed  Google Scholar 

  23. Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976) 28:140–142

    Article  Google Scholar 

  24. Teramoto T, Ohmori K, Takatsu T, Inoue H, Ishida Y, Suzuki K (1994) Long-term results of the anterior cervical spondylodesis. Neurosurgery 35:64–68

    Article  PubMed  CAS  Google Scholar 

  25. Thakar S, Ch M, Vedantam A, Rajshekhar V (2008) Correlation between change in graft height and change in segmental angle following central corpectomy for cervical spondylotic myelopathy. J Neurosurg Spine 9:158–166

    Article  PubMed  Google Scholar 

  26. Wang JC, Hart RA, Emery SE, Bohlman HH (2003) Graft migration or displacement after multilevel cervical corpectomy and strut grafting. Spine (Phila Pa 1976) 28:1016–1021, discussion 1021–1012

    Google Scholar 

  27. Zairi F, Aboukais R, Thines L, Allaoui M, Assaker R (2012) Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy. Eur Spine J 21:1545-1550

    Article  PubMed  Google Scholar 

  28. Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976) 16:726–729

    Article  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Albrecht Waschke, Szymon Kaczor, Jan Walter, Pedro Duenisch, Rolf Kalff & Christian Ewald

Authors
  1. Albrecht Waschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Szymon Kaczor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jan Walter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Pedro Duenisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rolf Kalff
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christian Ewald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albrecht Waschke.

Additional information

Comment

The authors studied the outcomes of cervical corpectomies and reconstructions using expandable titanium cages with anterior cervical plates (ACPs) in 48 non-traumatic cases (single level 31, multilevel 17) with a mean 2-year follow-up. The primary focus of the study was efficacy in achieving stability as well as in restoring and maintaining lordosis.

Stability of the fusion, as assessed by absence of motion of the spinous process, or osteoconduction along the surface of the implant, was reported to be achieved in 79% of the entire series (38 out of the 48). For the single-level corpectomy group, the rate was 90% (three failed out of 31). Whereas, when reading the manuscript critically, seven of 17 cases failed in the multilevel corpectomy group, and the fusion rate dropped to 59%.

Improvements in the alignments within the construct and in the entire C2-C7, were attained in the 2-year follow-up for the overall series, with a mean augmentation of 7.6 degrees and 5.4 degrees respectively.

The authors successfully demonstrated efficacy of the reconstruction, by and large in the typical situation represented in the series, where the single-level corpectomy was conducted for spondylosis or disk degeneration with stenosis. Regarding the subgroup undergoing two or three levels of corpectomy, as necessitated in the relatively rare categories such as elongated OPLL, efficacy to achieve fusion stability and alignment restoration remain to be validated.

In addition, this reviewer would suggest a further follow-up for the series, since ongoing improvements beyond the length of the follow-up period are occasionally observed after reconstruction with struts and ACPs.

Phyo Kim,

Utsunomiya, Japan

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waschke, A., Kaczor, S., Walter, J. et al. Expandable titanium cages for anterior column cervical reconstruction and their effect on sagittal profile: a review of 48 cases. Acta Neurochir 155, 801–807 (2013). https://doi.org/10.1007/s00701-013-1655-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1655-7

Keywords

Search

Navigation