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Iqbal J, Khan MM, Thabet A, Mohammed K, Scalia G, Chaurasia B. Successful management of cervical tuberculosis and severe kyphosis using polyetheretherketone expandable cage and titanium plate: A case report. Clin Case Rep 2024; 12:e8793. [PMID: 38634094 PMCID: PMC11021619 DOI: 10.1002/ccr3.8793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024] Open
Abstract
Key Clinical Message Successful management of cervical tuberculosis and severe kyphosis was achieved using a PEEK expandable cage and titanium plate, demonstrating favorable outcomes in restoring cervical alignment and stability. This approach represents a promising alternative for addressing complex cervical pathologies, highlighting the potential of PEEK-based interventions in surgical management. Abstract Cervical tuberculosis can lead to severe vertebral destruction and kyphosis, posing challenges in surgical management. Recent advancements, including the use of polyetheretherketone (PEEK) expandable cages and titanium plates, show promise in addressing multilevel cervical pathologies. This report details the successful treatment of a 27-year-old male with cervical tuberculosis and severe kyphosis. Surgical intervention involved prevertebral abscess evacuation, C5-C7 corpectomy, and insertion of a PEEK expandable cage with an anterior titanium plate. Postoperative care included a Philadelphia collar, and follow-up demonstrated restored cervical alignment and stability. The use of PEEK-based surgical interventions, as demonstrated in this case, represents a significant evolution in managing complex cervical conditions. The successful outcome highlights the potential benefits of PEEK expandable cages in addressing cervical tuberculosis and kyphosis. Further research is needed to validate these findings and establish PEEK-based interventions as a viable alternative in such cases.
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Affiliation(s)
- Javeed Iqbal
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Muhammad Mohsin Khan
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Abdulnasser Thabet
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Kazim Mohammed
- Department of NeurosurgeryHamad General Hospital – Surgical Specialty CenterDohaQatar
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck SurgeryGaribaldi HospitalCataniaItaly
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Darwich A, Vogel J, Dally FJ, Hetjens S, Gravius S, Faymonville C, Bludau F. Cervical vertebral body replacement using a modern in situ expandable and angulable corpectomy cage system: early clinical and radiological outcome. Br J Neurosurg 2023; 37:1101-1111. [PMID: 35361031 DOI: 10.1080/02688697.2022.2054946] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Vertebral body replacement (VBR) cages are commonly implanted to reconstruct the cervical vertebrae in cases of tumour, trauma, spondylodiscitis, and degeneration. Expandable cages have been widely used for this purpose; however, the lacking congruence at the implant-bone interface and consequent implant displacement were considered as a serious drawback of such systems. Aim of this study is to evaluate the early clinical and radiological outcome of a modern in situ not only expandable but also angulable cervical corpectomy cage system. METHODS A total of 42 patients who underwent a single or multilevel cervical VBR procedure were included and retrospectively evaluated in this single-centre case series. The neurological status was assessed using American Spinal Injury Association (ASIA) score. Complications were categorized into surgical (including implant-associated) and general medical. Radiographic parameters included regional angulation, segmental height, and coronal alignment. RESULTS Mean age was 59.5 ± 20.6 years. The recorded ASIA score improved postoperatively by 10 points (p 0.0001). Surgical including implant-associated complication rates were 19.05%. Radiographic evaluation showed a height gain of 11.2 mm (p < 0.0001), lordotic correction of 7° (p < 0.0001), and coronal alignment of 3° (p < 0.0001). At the last follow-up, loss of angulation correction of 1.9° (p 0.0002), subsidence of 1.92 mm (p 0.0006), and fusion rates of 68.42% were observed. CONCLUSIONS The use of an in situ angulable and expandable cage system in cervical VBR seems to offer better results compared to conventional static or expandable cages regarding segmental height gain, lordotic correction, and clinical improvement as well as low complication and revision rates. Significant height gain in multilevel surgeries is associated with higher rates of implant-associated complications.
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Affiliation(s)
- Ali Darwich
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Johannes Vogel
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Franz-Joseph Dally
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Svetlana Hetjens
- Institute of medical statistics and biomathematics, University Medical Centre, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Sascha Gravius
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Christoph Faymonville
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Frederic Bludau
- Department of Orthopedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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Lu T, Gao Z, Li J, Liu N, Wang Y, Liu C, He X. Construction of a new cervical anatomically adaptive titanium mesh cage based on measurements of cervical geometry: A morphological and cadaveric study. Exp Ther Med 2021; 22:1256. [PMID: 34603524 PMCID: PMC8453342 DOI: 10.3892/etm.2021.10691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/22/2021] [Indexed: 11/29/2022] Open
Abstract
Mismatch between the titanium mesh cage and cervical geometries is an important factor that induces subsidence in anterior cervical corpectomy and fusion (ACCF). The aim of the present study was to construct a new quadrate anatomically adaptive titanium mesh cage (AA-TMC) that matches well with the cervical geometries and segmental alignment in one- and two-level ACCF. Computed tomography (CT) scans of 54 individuals were used to measure the cervical endplate geometries. X-rays of 74 young individuals were used to measure the intervertebral body angle (IBA) and intervertebral body height (IBH) of the surgical segments. The AA-TMC was designed based on these measured parameters. A total of 18 cervical cadaveric specimens underwent successive one- and two-level ACCF using the AA-TMC. Postoperatively, the specimens underwent CT scanning to assess the degree of matching of the TMC-endplate interface (TEI), IBA and IBH. A TEI interval <0.5 mm was considered well matching. In the sagittal plane, 93.8% of the inferior endplates were arched, whereas 94.8% of the superior endplates were flat. In the coronal plane, 82.9% of the inferior endplates and 93.8% of the superior endplates were flat. A total of 91.7 and 94.4% of the TEIs were well matched in one- and two-level ACCF, respectively. The postoperative IBA and IBH values were consistent with the values of young individuals. The AA-TMC achieved good matching with cervical geometries and segmental alignment in one- and two-level ACCF, and is proposed for use in ACCF to increase the contact at the TEI and achieve sufficient lordosis restoration.
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Affiliation(s)
- Teng Lu
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Zhongyang Gao
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Jialiang Li
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Ning Liu
- Department of Spine Surgery, Hanzhong Central Hospital, Hanzhong, Shaanxi 723000, P.R. China
| | - Yibin Wang
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Chao Liu
- Department of Education, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
| | - Xijing He
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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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.
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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
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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.
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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.
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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.
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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
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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.
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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.
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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
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Clinical Comparison of Surgical Constructs for Anterior Cervical Corpectomy and Fusion in Patients With Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament: A Systematic Review and Meta-Analysis. Clin Spine Surg 2018; 31:247-260. [PMID: 29746262 DOI: 10.1097/bsd.0000000000000649] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN This is a systematic review and meta-analysis. OBJECTIVE To examine the differences in outcomes among current constructs and techniques for anterior cervical corpectomy and fusion (ACCF) in patients with single or multiple level cervical myelopathy (CM) secondary to cervical spondylosis or ossified posterior longitudinal ligament. SUMMARY OF BACKGROUND DATA The natural history of CM can be a progressive disease process. In such cases, where surgical decompression is indicated to halt the progression, ACCF is typically chosen for pathology located posterior to the vertebral body. Numerous studies have shown that decompression with appropriate stabilization not only halts progression, but also improves patient outcomes. However, several constructs are available for this procedure, all with variable outcomes. MATERIALS AND METHODS A systematic review was conducted using Cochrane Database, Medline, and PubMed. Only studies with a minimum patient population of 10, reporting on CM because of cervical spondylosis or ossified posterior longitudinal ligament were included; a minimum follow-up period of 12 months and 1 clinical and/or radiographic outcome were required. Studies examining patients with cervical trauma/fracture, tumor, and infection or revision cases were excluded. Data analysis was carried out with Microsoft Excel. RESULTS A total of 30 studies met the inclusion criteria for qualitative analysis, while 26 studies were included for quantitative analysis. Constructs that were reported in these studies included titanium mesh cages, nano-hydroxyapatite/polyamide 66 composite struts, bone graft alone, expandable corpectomy cages, and polyetheretherketone cages. Clinical outcomes included Japanese Orthopaedic Association and modified Japanese Orthopaedic Association scores, Visual Analog Scale scores, Neck Disability Index scores, and Nurick grades. Radiographic outcomes included C2-C7 and segmental Cobb angles and pseudarthrosis rates. Each construct type had variable and unique benefits and shortcomings. CONCLUSIONS ACCF is a common surgical option for CM, despite carrying certain risks expected of any anterior cervical approach. Several constructs are available for ACCF, all with variable clinical and radiographic outcomes.
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Nigro L, Tarantino R, Donnarumma P, Santoro A, Delfini R. C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review. JOURNAL OF SPINE SURGERY (HONG KONG) 2017; 3:300-303. [PMID: 28744517 DOI: 10.21037/jss.2017.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
C5 nerve root palsy is a well-known complication after anterior or posterior cervical decompression. Many theories have been proposed but the etiology is still unclear. The use of a winged expandable cage after single or multiple corpectomy is among the used techniques in reconstructing the cervical spine. Herein we report a case of C5 palsy after a three-level corpectomy and reconstruction using this device for the treatment of cervical spondylosis. In our case the preexisting foraminal stenosis, wide anterior decompression and partial improvement of cervical alignment were factors supposed contributing to the palsy.
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Affiliation(s)
- Lorenzo Nigro
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Tarantino
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Pasquale Donnarumma
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Delfini
- Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
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Nigro L, Tarantino R, Donnarumma P, Santoro A, Delfini R. A case of cervical tuberculosis with severe kyphosis treated with a winged expandable cage after double corpectomy. JOURNAL OF SPINE SURGERY 2017; 3:304-308. [PMID: 28744518 DOI: 10.21037/jss.2017.06.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this case report, we demonstrate that the use of a winged expandable cage was able to obtain good clinical and radiological results in a case of cervical tuberculosis with severe kyphosis. However, case series will be necessary to affirm its validity as a stand-alone device for similar cases with high risk of instability.
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Affiliation(s)
- Lorenzo Nigro
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Tarantino
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Pasquale Donnarumma
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Antonio Santoro
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Delfini
- Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy
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