1
|
Maillot C, Gaume M, Zoghlami M, Chanteux L, Boukebous B, Rousseau MA. Comparison of Three Grafting Options for Anterior Cervical Corpectomy and Fusion: A Retrospective 3-Arms Case Control Study. World Neurosurg 2024; 187:e517-e524. [PMID: 38679377 DOI: 10.1016/j.wneu.2024.04.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Anterior cervical corpectomy and fusion achieves foraminal radicular and central medullary decompression and spinal stabilization in staged lesions. Many bone graft materials have been developed for the reconstruction of cervical lordosis and the restoration of intervertebral height after corpectomy. The PolyEtherKetoneEtherKetoneKetone (PEKEKK) is a semicrystalline thermoplastic polymer that can be reinforced with carbon fibers to create long and highly fenestrated rectangular cervical cages for corpectomy. This study aimed to evaluate the radiological outcomes of an innovative PEKEEKK cage compared with others grafting options. METHODS Forty-five consecutive patients who underwent surgery with PEKEKK cages between 2017 and 2019 at a spine institution, were matched with 15 patients with a titanium mesh cylindrical cage (TMC) and 15 patients with a tricortical structural iliac bone graft. The restoration of vertebral height and cervical lordosis postoperatively, and subsidence of the construct were evaluated. Complications were reported. RESULTS The minimal follow-up was 5.1±2years. A better, but nonsignificant, postoperative gain in height was observed for PEKEKK (+8.1 ± 20%) and TMC cages (+8.2 ± 16%) than for iliac crest autograft reconstruction (+2.3 ± 15%, P = 0.119). The mean subsidence at the last follow-up was greater for TMC cages (-10.2 ± 13%), but was not significant, with -6.1 ± 10% for PEKEKK cages and -4.1 ± 7% for iliac crest autografts (P = 0.223). The gain in segmental cervical lordosis was significant (P < 0.001) and remained stable in all the groups. CONCLUSIONS Although an improvement in radiologic anatomical parameters can be achieved with all cage groups, the PEKEKK cage can be considered as a safe alternative for reducing subsidence.
Collapse
Affiliation(s)
- Cedric Maillot
- Department of Orthopaedic and Traumatological Surgery, Beaujon Hospital, University of Paris, APHP, Paris, France
| | - Mathilde Gaume
- University Institute for Spine Surgery, Armand Trousseau Hospital, Sorbonne University, Paris, France.
| | - Mohamed Zoghlami
- Department of Orthopaedic and Traumatological Surgery, Beaujon Hospital, University of Paris, APHP, Paris, France
| | - Lucas Chanteux
- Department of Orthopaedic and Traumatological Surgery, Beaujon Hospital, University of Paris, APHP, Paris, France
| | - Baptiste Boukebous
- Department of Orthopaedic and Traumatological Surgery, Beaujon Hospital, University of Paris, APHP, Paris, France
| | - Marc-Antoine Rousseau
- Department of Orthopaedic and Traumatological Surgery, Beaujon Hospital, University of Paris, APHP, Paris, France
| |
Collapse
|
2
|
Mao Y, Patel AA, Meade S, Benzel E, Steinmetz MP, Mroz T, Habboub G. Review of mechanisms of expandable spine surgery devices. Expert Rev Med Devices 2024; 21:381-390. [PMID: 38557229 DOI: 10.1080/17434440.2024.2337295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Expandable devices such as interbody cages, vertebral body reconstruction cages, and intravertebral body expansion devices are frequently utilized in spine surgery. Since the introduction of expandable implants in the early 2000s, the variety of mechanisms that drive expansion and implant materials have steadily increased. By examining expandable devices that have achieved commercial success and exploring emerging innovations, we aim to offer an in-depth evaluation of the different types of expandable cages used in spine surgery and the underlying mechanisms that drive their functionality. AREAS COVERED We performed a review of expandable spinal implants and devices by querying the National Library of Medicine MEDLINE database and Google Patents database from 1933 to 2024. Five major types of mechanical jacks that drive expansion were identified: scissor, pneumatic, screw, ratchet, and insertion-expansion. EXPERT OPINION We identified a trend of screw jack mechanism being the predominant machinery in vertebral body reconstruction cages and scissor jack mechanism predominating in interbody cages. Pneumatic jacks were most commonly found in kyphoplasty devices. Critically reviewing the mechanisms of expansion and identifying trends among effective and successful cages allows both surgeons and medical device companies to properly identify future areas of development.
Collapse
Affiliation(s)
- Yuncong Mao
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Arpan A Patel
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Seth Meade
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Edward Benzel
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Michael P Steinmetz
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Thomas Mroz
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Ghaith Habboub
- Center for Spine Health, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| |
Collapse
|
3
|
Gao H, Tian Z, Wang Y, Lou Z. Comparison study of anterior cervical zero-profile fusion cage (ROI-C) and traditional titanium plate plus fusion technique for the treatment of spinal cord type cervical spondylosis. Medicine (Baltimore) 2023; 102:e36651. [PMID: 38115244 PMCID: PMC10727562 DOI: 10.1097/md.0000000000036651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023] Open
Abstract
A retrospective comparative study. To compare and analyze the differences in the efficiency and safety of ROI-C and traditional titanium plate with fusion cage for the treatment of CSM patients. Clinical data of 105 patients with CSM who underwent surgical treatment at our hospital from January 2019 to December 2020 were retrospectively reviewed. Patients were divided into ROI-C and traditional groups according to the different fusion methods. The operation time, intraoperative blood loss, preoperative and postoperative JOA score, NDI score, cervical Cobb angle, intervertebral space height, and postoperative complications were recorded and compared between the 2 groups. A total of 105 patients were included in this study, with 57 patients in the ROI-C group and 48 patients in the traditional group. The baseline data were similar between the 2 groups (P > .05). The operative time, intraoperative blood loss, and the incidence of postoperative dysphagia were significantly lower in the ROI-C group than in the traditional group (P < .05). There were no significant differences in the JOA score, NDI score, cervical Cobb angle, intervertebral space height, the incidence of postoperative axial symptoms, and adjacent segment degeneration between the 2 groups (P > .05). However, both groups showed significant improvement in the JOA score, NDI score, cervical Cobb angle, and intervertebral space height compared with before surgery (P < .05). The ROI-C zero-profile internal fixation system and traditional titanium plates with fusion cages can achieve satisfactory clinical treatment results for CSM patients. However, ROI-C has advantages of a shorter operative time, less blood loss, and less postoperative dysphagia. Therefore, the ROI-C zero-profile internal fixation system can be safely and effectively used to treat patients with CSM.
Collapse
Affiliation(s)
- Haoran Gao
- Department of the Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, China
| | - Zhen Tian
- Department of the Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, China
| | - Yong Wang
- Department of the Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, China
| | - Zhaohui Lou
- Department of the Orthopedic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Henan, China
| |
Collapse
|
4
|
Byvaltsev VA, Kalinin AA, Belykh EG, Aliyev MA, Sanzhin BB, Kukharev AV, Dyussembekov YK, Shepelev VV, Riew KD. Clinical and radiological outcomes of one-level cervical corpectomy with an expandable cage for three-column uncomplicated subaxial type «B» injures: a multicenter retrospective study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1644-1654. [PMID: 36976341 DOI: 10.1007/s00586-023-07648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To evaluate the clinical and radiological results of the operative management of three-column uncomplicated type «B» subaxial injures treated with a one-level cervical corpectomy with an expandable cage. METHODS This study included 72 patients with a three-column uncomplicated type «B» subaxial injures who met the inclusion criteria, underwent a one-level cervical corpectomy with an expandable cage at one of three neurosurgical departments between 2005 and 2020, and were followed up for clinical and radiological outcomes at a minimum 3-yr follow-up. RESULTS There was a decrease in the VAS pain score from an average of 80 mm to 7 mm (p = 0.03); a decrease in the average NDI score from 62 to 14% (p = 0.01); excellent and good outcomes according to Macnab's scale were 93% (n = 67/72). There was an average change in the cervical lordosis (Cobb method) from -9.10 to -15.40 (p = 0.007), without significant loss of lordosis (p = 0.27). There was no significant degeneration of the adjacent levels by 3 years post-op. The fusion rate, using the Cervical Spine Research Society criteria, was poor: it was 62.5% (n = 45/72), and using the CT criteria, it was 65.3% (n = 47/72). 15.4% patients (n = 11/72) suffered complications. Statistical difference between the fusion and pseudoarthrosis (according to X-ray criteria) subgroups showed that there were no statistically significant differences in the smoking status, diabetes, chronic steroid use, cervical injury level, subtypes of AO type B subaxial injuries and types of expandable cage systems. CONCLUSIONS One-level cervical corpectomy with an expandable cage, despite a poor fusion rate, can be considered a feasible and relatively safe method for treating three-column uncomplicated subaxial type «B» injures, with the benefit of immediate stability, anatomical reduction, and direct decompression of the spinal cord. While no one in our series had any catastrophic complications, we did note a high complication rate.
Collapse
Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Evgenii G Belykh
- Department of Neurosurgery, New Jersey Medical School, Rutgers University, New York, USA
| | - Marat A Aliyev
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
- Department of Neurosurgery, City Clinical Hospital No. 7, Almaty, Kazakhstan
| | - Bair B Sanzhin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | | | | | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, 1477 Clinical Hospital, Vladivostok, Russia
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
- Department of Neurological Surgery, Weill Cornell Medical School, New York, USA
| |
Collapse
|
5
|
Zhang DX, Guo LX. Effect of different fixation methods on biomechanical property of cervical vertebral body replacement and fusion. Clin Biomech (Bristol, Avon) 2023; 101:105864. [PMID: 36563544 DOI: 10.1016/j.clinbiomech.2022.105864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/25/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The main purpose of this study was to examine the effect of different fixation methods (anterior fixation, self-stabilizing fixation and anterior-posterior fixation) on biomechanical property of vertebral body replacement and fusion. METHODS Three finite element models of cervical vertebral body replacement and fusion were established. The implanted models included artificial vertebral body and fixation system, and the loads imposed on the models included 75 N compression load and 1 Nm moment load. FINDINGS For anterior-posterior fixation, the cervical load was mainly transmitted by the posterior pedicle screw and rod (more than 50%), and the stress shielding problem was the most significant than the self-stabilizing and anterior fixation. Self-stabilizing fixation was more helpful to the fusion of implant and vertebrae, but the higher risk of vertebral body collapse was worthy of attention if the cervical spine with osteoporosis. The stress of bone was mainly concentrated around the screw hole. The maximum stress (20.03 MPa) was lower than the yield stress of cortical bone and the possibility of fracture around the fixation device of cervical spine was low. The anterior fixation could meet the requirement of vertebral body replacement and fusion, and the addition of posterior pedicle screws and rods might obtain better treatment in cases of severe spine injury or osteoporosis. INTERPRETATION The findings of this study may provide guidance on clinical treatments for choosing more appropriate fixation methods for different patients.
Collapse
Affiliation(s)
- Dong-Xiang Zhang
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang 110819, China.
| |
Collapse
|
6
|
Byvaltsev VA, Kalinin AA, Aliyev MA, Azhibekov NO, Shepelev VV, Riew KD. Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes. Neurosurgery 2021; 89:617-625. [PMID: 34270755 PMCID: PMC8440060 DOI: 10.1093/neuros/nyab240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers. OBJECTIVE To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis. METHODS We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up. RESULTS There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P = .02); a decrease in the Neck Disability Index average from 55% to 12% (P = .009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P = .01). There was a change in cervical lordosis (Cobb method) average from −9.3° to −15.1° (P = .002), without significant loss of lordosis (P = .63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays – 50% (n = 39/78) and using computed tomography (CT) – 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications. CONCLUSION To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.
Collapse
Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia.,Department of Traumatology, Orthopedics and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education - A Branch of the Federal State Budgetary Educational Institution of Continuing Professional Education "Russian Medical Academy of Continuing Professional Education" of the Ministry of Health of the Russian Federation, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia.,Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Marat A Aliyev
- Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | - Valerii V Shepelev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, New York, USA.,Department of Neurological Surgery, Weill Cornell Medical School, New York, New York, USA
| |
Collapse
|
7
|
Wang S, Zhu J, Sun K, Chen R, Cao J, You R, Liu A, Zhao F, Shi J. Clinical impact and imaging results after a modified procedure of ACDF: a prospective case-controlled study based on ninety cases with two-year follow-up. BMC Musculoskelet Disord 2021; 22:605. [PMID: 34217257 PMCID: PMC8254952 DOI: 10.1186/s12891-021-04229-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
Study design This is a prospective case-controlled study. Background To analyze the postoperative axial pain and cage subsidence of patients presenting with cervical spondylotic myelopathy (CSM) after a modified procedure of ACDF (mACDF). Methods Ninety patients with CSM were prospectively collected from 2014 to 2018. The patients were divided into spread group and non-spread group (48:42 ratio) according to the cage placement with or without releasing the Caspar cervical retractor after decompression. Spread group received conventional ACDF and non-spread group received mACDF. Patients were followed-up for at least 24 months after surgery. Radiologic data, including height of intervertebral space and Cobb Angle, were collected. Nervous system function was obtained using JOA scores, and level of pain was assessed using VAS scores. Results A total of 90 patients were enrolled and the patients were divided into spread group (n = 48) and none-spread group(n = 42). Cage subsidence of (spread group vs none-spread group) was (0.82 ± 0.68 vs 0.58 ± 0.81) mm, (0.64 ± 0.77 vs 0.34 ± 0.46) mm, (0.48 ± 0.43 vs 0.25 ± 0.28) mm, and (0.45 ± 0.47 vs 0.17 ± 0.32) mm at 3 months, 6 months, 12 months and 24 months, respectively. The period exhibiting the most decrease of the height of intervertebral space was 3 months postoperatively. However, there was no statistical difference in the height of intervertebral space, JOA or VAS scores at the final follow-up between the two groups. Conclusions The mACDF can avoid excessive distraction by releasing the Caspar Cervical retractor, restore the “natural height” of cervical vertebra, relieve immediate pain after surgery, and prevent rapid Cage subsidence and the loss of cervical curvature.
Collapse
Affiliation(s)
- Shunmin Wang
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Jian Zhu
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Rongzi Chen
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Jie Cao
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Ruijin You
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Aigang Liu
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China
| | - Feng Zhao
- 910 Hospital of China Joint Logistics Support Force, 180 Garden Road, Fengze District, Quanzhou City, Fujian Province, China.
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Second Military Medical University, No.415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| |
Collapse
|
8
|
Doherty RJ, Wahood W, Yolcu YU, Alvi MA, Elder BD, Bydon M. Determining the Difference in Clinical and Radiologic Outcomes Between Expandable and Nonexpandable Titanium Cages in Cervical Fusion Procedures: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 149:249-264.e1. [PMID: 33516869 DOI: 10.1016/j.wneu.2021.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Expandable cages have been increasingly used in cervical and lumbar reconstructions; however, there is a paucity in the literature on how they compare with traditional nonexpandable cages in the cervical spine. We present a systematic review and meta-analysis, comparing the clinical and radiologic outcomes of expandable versus nonexpandable corpectomy cage use in the cervical spine. METHODS A database search identified studies detailing the outcomes of expandable and nonexpandable titanium cage use in the cervical spine. These studies were screened using the PRISMA protocol. Fixed-effects and random-effects models were used with a 95% confidence interval. Two analyses were carried out for each outcome: one including all studies and the other including only studies reporting on exclusively 1-level and 2-level cases. RESULTS Forty-one studies were included. The mean change in segmental lordosis was significantly greater in expandable cages (all, 6.72 vs. 3.69°, P < 0.001; 1-level and 2-level, 6.81° vs. 4.31°, P < 0.001). The mean change in cervical lordosis was also significantly greater in expandable cages (all, 5.71° vs. 3.11°, P = 0.027; 1-level and 2-level, 5.71° vs. 2.07°, P = 0.002). No significant difference was found between the complication rates (all, P = 0.43; 1-level and 2-level, P = 0.94); however, the proportion of revisions was significantly greater in expandable cages (all, 0.06 vs. 0.02, P = 0.03; 1-level and 2-level, 0.08 vs. 0.01, P = 0.017). CONCLUSIONS The use of expandable cages may carry a modest improvement in radiologic outcomes compared with nonexpandable cages in the cervical spine; however, they may also lead to a higher rate of revisions based on our analyses.
Collapse
Affiliation(s)
- Ronan J Doherty
- School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Waseem Wahood
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA
| | - Yagiz U Yolcu
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohammed Ali Alvi
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
| |
Collapse
|
9
|
Yusupov N, Siller S, Hofereiter J, Boehm HK, Fuetsch M, Tonn JC, Zausinger S. Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation. Oper Neurosurg (Hagerstown) 2020; 20:109-118. [PMID: 33026443 DOI: 10.1093/ons/opaa296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. OBJECTIVE To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. METHODS Between 2011 and 2017, 40 patients underwent a single-level (N = 32) or 2-level (N = 8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. RESULTS Mean last follow-up was 14.8 ± 7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (>1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. CONCLUSION Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.
Collapse
Affiliation(s)
- Natan Yusupov
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siller
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Johann Hofereiter
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Manuel Fuetsch
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Stefan Zausinger
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
10
|
Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients. ACTA ACUST UNITED AC 2020; 56:medicina56120642. [PMID: 33255605 PMCID: PMC7760022 DOI: 10.3390/medicina56120642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 12/16/2022]
Abstract
Background and objectives: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Materials and Methods: Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Scale) and gait disturbances with the Nurick score. Radiographic analysis comprised measurement of fusion, subsidence and the C2–C7 angle. Results: Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastasis (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). In 39 patients (45.3%), additional dorsal stabilization (360° fusion) was performed. In 13 patients, hardware failure occurred, and in 8 patients, adjacent segment disease occurred. Improvement of pain symptoms, myelopathy, and gait following surgery were statistically significant (p < 0.05), with a medium preoperative VAS of 8, a postoperative score of 3.2, and medium EMS scores of 11.3 preoperatively vs. 14.3 postoperatively. Radiographic analysis showed successful fusion in 74 patients (86%). As shown in previous studies, correction of the C2–C7 angle did not correlate with improvement of neurological symptoms. Conclusion: Our results show that expandable titanium cages are a safe and useful tool in anterior cervical corpectomies for providing adequate anterior column support and stability.
Collapse
|
11
|
Rezaei A, Giambini H, Miller AL, Liu X, Elder BD, Yaszemski MJ, Lu L. OPF/PMMA cage system as an alternative approach for the treatment of vertebral corpectomy. APPLIED SCIENCES (BASEL, SWITZERLAND) 2020; 10:6912. [PMID: 33986953 PMCID: PMC8115301 DOI: 10.3390/app10196912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The spinal column is the most common site for bone metastasis. Vertebral metastases with instability have historically been treated with corpectomy of the affected vertebral body and adjacent intervertebral discs, and are more recently treated with separation surgery. With demographics shifting towards an elderly population, a less invasive surgical approach is necessary for the repair of vertebral defects. We have modified a previously reported expandable hollow cage composed of an oligo[poly(ethylene glycol) fumarate] (OPF) containment system that could be delivered via a posterior-only approach. Then, the polymer of interest, poly(methyl methacrylate) (PMMA) bone cement, was injected into the lumen of the cage after expansion to form an OPF/PMMA cage. We compared six different cage formulations to account for vertebral body and defect size, and performed a cage characterization via expansion kinetics and mechanical testing evaluations. Additionally, we investigated the feasibility of the OPF/PMMA cage in providing spine stability via kinematic analyses. The in-vitro placement of the implant using our OPF/PMMA cage system showed improvement and mechanical stability in a flexion motion. The results demonstrated that the formulation and technique presented in the current study have the potential to improve surgical outcomes in minimally invasive procedures on the spine.
Collapse
Affiliation(s)
- Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Giambini
- Department of Biomedical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Alan L. Miller
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Benjamin D. Elder
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Michael J. Yaszemski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
12
|
Cappelletto B, Giorgiutti F, Balsano M. Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine. J Orthop Surg (Hong Kong) 2020; 28:2309499019900472. [PMID: 31994969 DOI: 10.1177/2309499019900472] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. METHODS Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single (n = 34), double (n = 4), or triple (n = 1) corpectomy. Pathologies were tumors (n = 21), fractures, or deformities in traumatic injuries (n = 14), degenerative pathology (n = 2), and infection (n = 2). Levels were cervical (n = 10), thoracic (n = 14), and lumbar (n = 15). All patients were evaluated clinically and radiographically. RESULTS There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative (p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. CONCLUSIONS In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.
Collapse
Affiliation(s)
- Barbara Cappelletto
- Spine and Spinal Cord Surgical Unit, ASUIUD, Presidio Ospedaliero-Universitario Santa Maria della Misericordia di Udine, Udine, Italy
| | - Fabrizia Giorgiutti
- Spine and Spinal Cord Surgical Unit, ASUIUD, Presidio Ospedaliero-Universitario Santa Maria della Misericordia di Udine, Udine, Italy
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, AOUI, Verona, Italy
| |
Collapse
|
13
|
Bydon M, Goyal A, Yolcu YU. Novel Intervertebral Technologies. Neurosurg Clin N Am 2020; 31:49-56. [PMID: 31739929 DOI: 10.1016/j.nec.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Surgical procedures, such as spinal fusion and disk replacement, are commonly used for treatment following failure of conservative treatment in degenerative spine disease. However, there is growing consensus that currently available surgical technologies may have long-term inefficacy for successful management. Intervertebral disk degeneration is the most common manifestation of degenerative spine disease, hence, replacement/repair of this tissue is an important component of surgical treatment. Restoration of spinal alignment and preservation of natural kinematics is also essential to a good outcome. This article reviews novel intervertebral implant technologies that have the potential to significantly impact elective spine surgery for degenerative spine disease.
Collapse
Affiliation(s)
- Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Charlton building, Room 6-124, 201 West Center Street, Rochester, MN 55902, USA.
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Charlton building, Room 6-124, 201 West Center Street, Rochester, MN 55902, USA
| | - Yagiz U Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Charlton building, Room 6-124, 201 West Center Street, Rochester, MN 55902, USA
| |
Collapse
|
14
|
Hartmann S, Wipplinger C, Tschugg A, Kavakebi P, Örley A, Girod PP, Thomé C. Thoracic corpectomy for neoplastic vertebral bodies using a navigated lateral extracavitary approach-a single-center consecutive case series: technique and analysis. Neurosurg Rev 2017; 41:575-583. [PMID: 28819694 DOI: 10.1007/s10143-017-0895-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/08/2017] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
Abstract
Thoracic myelopathy is often caused by vertebral body fractures resulting from neoplastic conditions, traumatic events, or infectious diseases. One of the preferred procedures for treating it is the lateral extracavitary approach (LECA) with single-level or multilevel decompressive corpectomy and reconstruction. The aim of this retrospective study was to analyze the thoracic lateral extracavitary approach with corpectomy using vertebral body replacement systems (VBR-S) and dorsal reconstruction. Twenty-four patients with metastatic or primary lesions of thoracic vertebrae T2-T12 underwent spinal decompression and ventral column reconstruction with correction of spinal deformity via a LECA. One-level to four-level corpectomies were performed with additional navigated dorsal pedicle screw fixation at an average of two levels above and below the corpectomy lesion. None of the patients received preoperative spinal embolization, and the majority of the patients were admitted to radiotherapy postoperatively. Their mean age was 56 years (± 15), with a female-to-male sex ratio of 8 to 16. Patients with a minimum follow-up period of 16 months were included. The Karnofsky index, preoperative and postoperative numeric rating scale (NRS), and Frankel scale were measured. In addition, intraoperative loss of blood (LOB), units of packed red blood cell (PRBC) transfusions, the duration of the operation, and the hospitalization period were evaluated and correlated with preoperative and postoperative values. The majority of the patients were suffering from metastatic lesions and were treated with a 1 level corpectomy (median 1 level, range 1 to 4). The mean duration of surgery was 288 min (± 121) and the mean LOB was 1626 mL (± 1486 mL), with approximately two PRBC units per patient used. All patients were transferred to the intensive care unit (ICU) postoperatively, with a mean ICU stay of 2.0 days (± 1 day). The mean hospitalization period was 13 days (± 7 days). No implant-related failures or procedure-related deaths were observed. Significant differences were noted between the preoperative and postoperative Karnofsky index (74 vs. 84%) and NRS (4 vs. 2). One patient required revision surgery due to a superficial wound infection, and another needed revision surgery due to a dural tear. In another patient, an iatrogenic dural tear was repaired during the same surgical procedure and did not lead to postoperative complications. Four pleural effusions and one pneumothorax were observed, so that the overall complication rate was approximately 33%. Four of the patients died within 2 years of the operation due to progression of the primary disease. Lateral corpectomy and sagittal reconstruction of the thoracic spine using VBR-S conducted via a navigated LECA approach yields favorable results, despite the burden of neoplastic disease. These challenging procedures are accompanied by increased LOB and hospitalization periods, with moderate transfusion requirements. Surgery-related complications are low and local tumor control is satisfactory, despite the progression of the underlying neoplastic disease. However, optimal surgical therapy does not ensure long-term survival.Study design Retrospective analysis of thoracic corpectomiesLevel of evidence 4.
Collapse
Affiliation(s)
- Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Christoph Wipplinger
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Anja Tschugg
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Pujan Kavakebi
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Örley
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Pierre Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| |
Collapse
|
15
|
Chiriac A, Faiyad Z, Popescu C, Costachescu B, Poeata I. Our first experience with cervical expandable cage for vertebral body reconstruction. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM)
Collapse
|