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

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.

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

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.