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

Acta Neurochirurgica volume 155, pages 801–807 (2013)Cite this article

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.

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Conflicts of interest

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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
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  2. Szymon Kaczor
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  3. Jan Walter
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  4. Pedro Duenisch
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  5. Rolf Kalff
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  6. Christian Ewald
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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

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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

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

Keywords

  • Cervical spine
  • Corpectomy
  • Expandable cervical cage
  • Sagittal profile