Acta Neurochirurgica

, Volume 155, Issue 5, pp 801–807 | Cite as

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

  • Albrecht Waschke
  • Szymon Kaczor
  • Jan Walter
  • Pedro Duenisch
  • Rolf Kalff
  • Christian Ewald
Clinical Article - Spine



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.


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.


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.


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.


Cervical spine Corpectomy Expandable cervical cage Sagittal profile 


Conflicts of interest



  1. 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 544–535PubMedCrossRefGoogle Scholar
  2. 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 4:285–291PubMedCrossRefGoogle Scholar
  3. 3.
    Barnes B, Haid RW, Rodts GE, Subach BR, Kaiser M (2002) Early results using the Atlantis anterior cervical plate system. Neurosurg Focus 12:E13PubMedCrossRefGoogle Scholar
  4. 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 85:206–210PubMedCrossRefGoogle Scholar
  5. 5.
    Brown JA, Havel P, Ebraheim N, Greenblatt SH, Jackson WT (1988) Cervical stabilization by plate and bone fusion. Spine (Phila Pa 1976) 13:236–240CrossRefGoogle Scholar
  6. 6.
    Burkett CJ, Baaj AA, Dakwar E, Uribe JS (2012) Use of titanium expandable vertebral cages in cervical corpectomy. J Clin Neurosci 19:402–405PubMedCrossRefGoogle Scholar
  7. 7.
    Buttermann GR, Glazer PA, Bradford DS (1996) The use of bone allografts in the spine. Clin Orthop Relat Res :75–85Google Scholar
  8. 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:E15PubMedCrossRefGoogle Scholar
  9. 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 13:233–238PubMedCrossRefGoogle Scholar
  10. 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 94:174–178PubMedGoogle Scholar
  11. 11.
    Eleraky MA, Llanos C, Sonntag VK (1999) Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg 90:35–41PubMedCrossRefGoogle Scholar
  12. 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 8–9PubMedCrossRefGoogle Scholar
  13. 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 99:91–97PubMedGoogle Scholar
  14. 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 21:606–612PubMedGoogle Scholar
  15. 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 96:10–16PubMedGoogle Scholar
  16. 16.
    Narotam PK, Pauley SM, McGinn GJ (2003) Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 99:172–180PubMedGoogle Scholar
  17. 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 9:893–898PubMedCrossRefGoogle Scholar
  18. 18.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100PubMedCrossRefGoogle Scholar
  19. 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 33:87–92PubMedCrossRefGoogle Scholar
  20. 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 30:587–592PubMedCrossRefGoogle Scholar
  21. 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 99:98–103PubMedGoogle Scholar
  22. 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 804–795PubMedCrossRefGoogle Scholar
  23. 23.
    Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine (Phila Pa 1976) 28:140–142CrossRefGoogle Scholar
  24. 24.
    Teramoto T, Ohmori K, Takatsu T, Inoue H, Ishida Y, Suzuki K (1994) Long-term results of the anterior cervical spondylodesis. Neurosurgery 35:64–68PubMedCrossRefGoogle Scholar
  25. 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 9:158–166PubMedCrossRefGoogle Scholar
  26. 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 1021–1012Google Scholar
  27. 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 21:1545-1550PubMedCrossRefGoogle Scholar
  28. 28.
    Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976) 16:726–729CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Albrecht Waschke
    • 1
  • Szymon Kaczor
    • 1
  • Jan Walter
    • 1
  • Pedro Duenisch
    • 1
  • Rolf Kalff
    • 1
  • Christian Ewald
    • 1
  1. 1.Department of NeurosurgeryJena University Hospital - Friedrich Schiller University JenaJenaGermany

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