Abstract
Background
In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment.
Methods
This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion–extension radiographs at 2 years.
Results
The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p < 0.05). The mean kyphosis angle decreased from 17° to 2° at the last follow-up (p < 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.
Conclusion
Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.
Similar content being viewed by others
References
Kadanka Z, Mares M, Bednarika J, Smrca V, Krbec M, Chaloupka R, Dusek L (2005) Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol 12:16–24
Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine 26:1443–1447
Wittenberg RH, Moeller J, Shea M, White AA, Hayes WC (1990) Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion. Spine 15:1073–1078
Kinoshita A, Kataoka K, Taneda M (1999) Multilevel vertebral body replacement with a titanium mesh spacer for aneurysmal bone cyst: technical note. Minim Invasive Neurosurg 42:156–158
Dorai Z, Morgan H, Coimbra C (2003) Titanium cage reconstruction after cervical corpectomy. J Neurosurg 99:3–7
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
Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295
Woiciechowsky C (2005) Distractable vertebral cages for reconstruction after cervical corpectomy. Spine 30:1736–1741
Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617
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
Kristof RA, Kiefer T, Thudium M, Ringel F, Stoffel M, Kovacs A, Mueller CA (2009) Comparison of ventral corpectomy and plate–screw-instrumented fusion with dorsal laminectomy and rod–screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy. Eur Spine J 18(12):1951–1956
Dickerman RD, Reynolds AS, Bennett M (2010) Cervical spondylotic myelopathy: a complex problem where approach is patient dependent. Eur Spine J 19(1):150–151
Ghogawala Z, Martin B, Benzel EC, Dziura J, Magge SN, Abbed KM et al (2011) Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy. Neurosurgery 68(3):622–630
Bapat MR, Chaudhary K, Sharma A, Laheri V (2008) Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases. Eur Spine J 17(12):1651–1663
Matz PG, Pritchard PR, Hadley MN (2007) Anterior cervical approach for the treatment of cervical myelopathy. Neurosurgery 60:S64–S70
Wang JC, McDonough PW, Endow KK, Delamarter RB (2001) A comparison of fusion rates between single-level cervical corpectomy and two-level discectomy and fusion. J Spinal Disord 14:222–225
Lin Q, Zhou X, Wang X, Cao P, Tsai N, Yuan W (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21(3):474–481
Bazaz R, Lee MJ, Yoo JU (2002) Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 27:2453–2458
Thongtrangan I, Balabhadra RS, Le H, Park J, Kim DH (2003) Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection. Neurosurg Focus 15:E8
Liljenqvist U, Lerner T, Bullmann V, Hackenberg L, Halm H, Winkelmann W (2003) Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:606–612
Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV (2003) Early reconstruction failures after multilevel cervical corpectomy. Spine 28:140–142
Vaccaro AR, Falatyn SP, Scuderi GJ, Eismont FJ, McGuire RA, Singh K, Garfin SR (1998) Early failure of long segment anterior cervical plate fixation. J Spinal Disord 11:410–415
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zaïri, F., Aboukais, R., Thines, L. et al. Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy. Eur Spine J 21, 1545–1550 (2012). https://doi.org/10.1007/s00586-012-2380-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-012-2380-2