Expandable cylindrical cages in the cervical spine: a review of 22 cases

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Object

Expandable cylindrical cages (ECCs) have been utilized successfully to reconstruct the thoracic and lumbar spine. Their advantages include ease of insertion, reduced endplate trauma, direct application/maintenance of interbody distraction force, and one-step kyphosis correction. The authors present their experience with ECCs in the reconstruction of the cervical spine in patients with various pathological conditions.

Methods

Data obtained in 22 patients were reviewed retrospectively. A standard anterior cervical corpectomy was performed in all cases. Local vertebral body bone was harvested for use as graft material. Patients underwent pre- and postoperative assessment involving the visual analog scale (VAS), Nurick grading system for determining myelopathy disability, and radiographic studies to determine cervical kyphosis/lordosis and cage subsidence. Fusion was defined as the absence of motion on flexion–extension x-ray films.

Sixteen patients presented with spondylotic myelopathy, two with osteomyelitis, two with fracture, one with tumor metastasis, and one with severe stenosis. Fourteen patients underwent supplemental posterior spinal fusion, seven underwent single-level corpectomy, and 15 patients underwent multilevel corpectomy. No perioperative complications occurred. The mean follow-up period was 22 months. In 11 patients with preexisting kyphosis (mean deformity +19°), the mean correction was 22°. There was no statistically significant difference in subsidence between single- and multilevel corpectomy or between 360º fusion and anterior fusion alone. The VAS scores improved by 35%, and the Nurick grade improved by 31%. The fusion rate was 100%.

Conclusions

The preliminary results support the use of ECCs in the cervical spine in the treatment of patients with various disease processes. No significant subsidence was noted, and pain and functional scores improved in all cases. Expandable cylindrical cages appear to be well suited for cervical reconstruction and for correcting sagittal malalignment.

Abbreviations used in this paper:ACDF = anterior cervical discectomy and fusion; ECC = expandable cylindrical cage; RCC = renal cell carcinoma; TMC = titanium mesh cage; VAS = visual analog scale; VB = vertebral body.

Article Information

Address reprint requests to: Christopher P. Ames, M.D., De-

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    A and B: Imaging studies obtained in a 78-year-old woman with a history of progressive myelopathy and kyphotic deformity centered at C-5. The patient underwent a C4–6 corpectomy and cage placement, as well as the insertion of a C3–6 anterior plate and C3–T1 posterior instrumentation. C: Because of the patient's age, bone quality, and the proximity of the cage to the cervicothoracic junction, we chose to stabilize the supplemental posterior construct by extending it to T-1.

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    A and B: Sagittal MR images obtained in a 41-year-old man with a history of RCC metastatic to the C-6 and C-7 VBs. C: The patient underwent C-6 and C-7 corpectomies and cage placement, implantation of C5–T1 anterior plate, and supplemental C4–T3 posterior fusion, two levels above and two levels below the anterior construct. Because of the degree of neoplastic involvement of C-6 and C-7, the posterior instrumentation was extended across the cervicothoracic junction down to T-3.

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    A: Sagittal MR image obtained in a 50-year-old woman with a history of C3–4 ACDF and laminoplasty and progressive kyphotic deformity centered at C-5. B: Her old hardware was removed, and she underwent a C-5 corpectomy with cage placement, and the implantation of a C2–6 anterior plate and C2–T2 posterior instrumentation. Because of the extent of anterior reconstruction, we chose to extend a posterior construct across the cervicothoracic junction.

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    Bar graphs showing the mean pre- and postoperative VAS scores and Nurick grades acquired in patients who underwent corpectomy and ECC placement. Upper: The mean preoperative VAS score was 7.3 ± 1.5, and the mean postoperative score was 2.6 ± 1.5. Lower: The mean preoperative Nurick grade was 3.2 ± 0.8, whereas the mean postoperative grade was 2.2 ± 0.9. The differences were statistically significant (*p <0.05).

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    Bar graphs showing the mean subsidence of ECCs based on the number of corpectomy levels performed. Left: The mean cage subsidence values for one-, two-, and three-level corpectomies were 2.3 ± 3.7, 1.8 ± 2.7, and 6.5 ± 7.8 mm, respectively. There were no statistically significant differences in subsidence for one compared with two levels, one compared with three levels, and two compared with three levels (p = 0.38, p = 0.29, and p = 0.27, respectively), although a trend toward statistical significance was noted. Right: The mean subsidence of cervical ECCs in patients who underwent 360° fusion compared with those who underwent anterior spinal fusion alone. In patients with anterior and posterior instrumentation the mean subsidence was 1.6 ± 3.5 mm. In patients with anterior instrumentation alone the mean subsidence was 2.8 ± 3.7 mm. The difference in subsidence for 360° fusion compared with anterior fusion alone was not statistically significant (p = 0.24).

References

  • 1

    Bailey RWBadgley CE: Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg Am 42:5655941960

  • 2

    Bazaz RLee MJYoo JU: Incidence of dysphagia after anterior cervical spine surgery: a prospective study. Spine 27:245324582002

  • 3

    Bernhardt MHynes RABlume HWWhite AA III: Cervical spondylotic myelopathy. J Bone Joint Surg Am 75:1191281993

  • 4

    Bishop RCMoore KAHadley MN: Anterior cervical interbody fusion using autogeneic and allogeneic bone graft substrate: a prospective comparative analysis. J Neurosurg 85:2062101996

    • Search Google Scholar
    • Export Citation
  • 5

    Brantigan JWMcAfee PCCunningham BWWang HOrbegoso CM: Interbody lumbar fusion using a carbon fiber cage implant versus allograft bone. An investigational study in the Spanish goat. Spine 19:143614441994

    • Search Google Scholar
    • Export Citation
  • 6

    Brodke DSZdeblick TA: Modified Smith-Robinson procedure for anterior cervical discectomy and fusion. Spine 17:S427S4301992

  • 7

    Buttermann GRGlazer PABradford DS: The use of bone allografts in the spine. Clin Orthop Relat Res 324:75851996

  • 8

    Clausen JDRyken TCTraynelis VCSawin PDDexter FGoel VK: Biomechanical evaluation of Caspar and Cervical Spine Locking Plate systems in a cadaveric model. J Neurosurg 84:103910451996

    • Search Google Scholar
    • Export Citation
  • 9

    Cloward RB: The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:6026171958

  • 10

    Connolly PJEsses SIKostuik JP: Anterior cervical fusion: outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 9:2022061996

    • Search Google Scholar
    • Export Citation
  • 11

    DePalma AFRothman RHLewinnek GECanale ST: Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:7557581972

    • Search Google Scholar
    • Export Citation
  • 12

    Dorai ZMorgan HCoimbra C: Titanium cage reconstruction after cervical corpectomy. J Neurosurg 99:1 Suppl372003

  • 13

    Ebraheim NADeTroye RJRupp RETaha JBrown JJackson WT: Osteosynthesis of the cervical spine with an anterior plate. Orthopedics 18:1411471995

    • Search Google Scholar
    • Export Citation
  • 14

    Eck KRBridwell KHUngacta FFLapp MALenke LGRiew KD: Analysis of titanium mesh cages in adults with minimum two-year follow-up. Spine 25:240724152000

    • Search Google Scholar
    • Export Citation
  • 15

    Eleraky MALlanos CSonntag VK: Cervical corpectomy: report of 185 cases and review of the literature. J Neurosurg 90:1 Suppl35411999

    • Search Google Scholar
    • Export Citation
  • 16

    Emery SEBolesta MJBanks MAJones PK: Robinson anterior cervical fusion comparison of the standard and modified techniques. Spine 19:6606631994

    • Search Google Scholar
    • Export Citation
  • 17

    Fathie K: Anterior cervical diskectomy and fusion with methyl methacrylate. Mt Sinai J Med 61:2462471994

  • 18

    Fernyhough JCSchimandle JJWeigel MCEdwards CCLevine AM: Chronic donor site pain complicating bone graft harvesting from the posterior iliac crest for spinal fusion. Spine 17:147414801992

    • Search Google Scholar
    • Export Citation
  • 19

    Fernyhough JCWhite JILaRocca H: Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine 16:S561S5641991

    • Search Google Scholar
    • Export Citation
  • 20

    Foley KTDiAngelo DJRampersaud YRVossel KAJansen TH: The in vitro effects of instrumentation on multilevel cervical strut-graft mechanics. Spine 24:236623761999

    • Search Google Scholar
    • Export Citation
  • 21

    Goffin JPlets CVan den Bergh R: Anterior cervical fusion and osteosynthetic stabilization according to Caspar: a prospective study of 41 patients with fractures and/or dislocations of the cervical spine. Neurosurgery 25:8658711989

    • Search Google Scholar
    • Export Citation
  • 22

    Griffith SLZogbi SWGuyer RDShelekov APContiliano JHGeiger JM: Biomechanical comparison of anterior instrumentation for the cervical spine. J Spinal Disord 8:4294381995

    • Search Google Scholar
    • Export Citation
  • 23

    Grossman WPeppelman WCBaum JAKraus DR: The use of freeze-dried fibular allograft in anterior cervical fusion. Spine 17:5655691992

    • Search Google Scholar
    • Export Citation
  • 24

    Hafez RFCrockard HA: Failure of osseous conduction with cervical interbody BOP graft. Br J Neurosurg 11:57591997

  • 25

    Herkowitz HN: The surgical management of cervical spondylotic radiculopathy and myelopathy. Clin Orthop Relat Res 239:941081989

  • 26

    Herman JMSonntag VK: Cervical corpectomy and plate fixation for postlaminectomy kyphosis. J Neurosurg 80:9639701994

  • 27

    Hilibrand ASFye MAEmery SEPalumbo MABohlman HH: Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine 27:1461512002

    • Search Google Scholar
    • Export Citation
  • 28

    Hollowell JPVollmer DGWilson CRPintar FAYoganandan N: Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate?. Spine 21:103210361996

    • Search Google Scholar
    • Export Citation
  • 29

    Hosono NYonenobu KFuji TEbara SYamashita KOno K: Orthopaedic management of spinal metastases. Clin Orthop Relat Res 312:1481591995

    • Search Google Scholar
    • Export Citation
  • 30

    Johnston FGCrockard HA: One-stage internal fixation and anterior fusion in complex cervical spinal disorders. J Neurosurg 82:2342381995

    • Search Google Scholar
    • Export Citation
  • 31

    Kandziora FPflugmacher RSchaefer JScholz MLudwig KSchleicher P: Biomechanical comparison of expandable cages for vertebral body replacement in the cervical spine. J Neurosurg 99:1 Suppl91972003

    • Search Google Scholar
    • Export Citation
  • 32

    Kim PWakai SMatsuo SMoriyama TKirino T: Bisegmental cervical interbody fusion using hydroxyapatite implants: surgical results and long-term observation in 70 cases. J Neurosurg 88:21271998

    • Search Google Scholar
    • Export Citation
  • 33

    Liljenqvist ULerner TBullmann VHackenberg LHalm HWinkelmann W: Titanium cages in the surgical treatment of severe vertebral osteomyelitis. Eur Spine J 12:6066122003

    • Search Google Scholar
    • Export Citation
  • 34

    Macdonald RLFehlings MGTator CHLozano AFleming JRGentili F: Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86:9909971997

    • Search Google Scholar
    • Export Citation
  • 35

    Majd MEVadhva MHolt RT: Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24:160416101999

  • 36

    Malinin TIBrown MD: Bone allografts in spinal surgery. Clin Orthop Relat Res 154:68731981

  • 37

    Matsui HTatezaki STsuji H: Ceramic vertebral body replacement for metastatic spine tumors. J Spinal Disord 7:2482541994

  • 38

    Mayr MTSubach BRComey CHRodts GEHaid RW Jr: Cervical spinal stenosis: outcome after anterior corpectomy, allograft reconstruction, and instrumentation. J Neurosurg 96:1 Suppl10162002

    • Search Google Scholar
    • Export Citation
  • 39

    Miller DJLang FFWalsh GLAbi-Said DWildrick DMGokaslan ZL: Coaxial double-lumen methylmethacrylate reconstruction in the anterior cervical and upper thoracic spine after tumor resection. J Neurosurg 92:2 Suppl1811902000

    • Search Google Scholar
    • Export Citation
  • 40

    Naderi SAlberstone CDRupp FWBenzel ECBaldwin NG: Cervical spondylotic myelopathy treated with corpectomy: technique and results in 44 patients. Neurosurg Focus 1:6E51996

    • Search Google Scholar
    • Export Citation
  • 41

    Narotam PKPauley SMMcGinn GJ: Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. J Neurosurg 99:2 Suppl1721802003

    • Search Google Scholar
    • Export Citation
  • 42

    Orr RDZdeblick TA: Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop Relat Res 359:58661999

  • 43

    Porter RWCrawford NRChamberlain RHPark SCDetwiler PWApostolides PJ: Biomechanical analysis of multilevel cervical corpectomy and plate constructs. J Neurosurg 99:1 Suppl981032003

    • Search Google Scholar
    • Export Citation
  • 44

    Reynolds AF JrTurner PTLoeser JD: Fracture of the anterior superior iliac spine following anterior cervical fusion using iliac crest. Case report. J Neurosurg 48:8098101978

    • Search Google Scholar
    • Export Citation
  • 45

    Sasso RCRuggiero RA JrReilly TMHall PV: Early reconstruction failures after multilevel cervical corpectomy. Spine 28:1401422003

    • Search Google Scholar
    • Export Citation
  • 46

    Saunders RLBernini PMShirreffs TG JrReeves AG: Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:1631701991

    • Search Google Scholar
    • Export Citation
  • 47

    Schultz KD JrMcLaughlin MRHaid RW JrComey CHRodts GE JrAlexander J: Single-stage anterior-posterior decompression and stabilization for complex cervical spine disorders. J Neurosurg 93:2 Suppl2142212000

    • Search Google Scholar
    • Export Citation
  • 48

    Seifert V: Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis. Pathophysiological considerations, surgical indication, results and complications: a survey. Acta Neurochir (Wien) 135:1051211995

    • Search Google Scholar
    • Export Citation
  • 49

    Silber JSAnderson DGDaffner SDBrislin BTLeland JMHilibrand AS: Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 28:1341392003

    • Search Google Scholar
    • Export Citation
  • 50

    Smith GWRobinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40:6076241958

    • Search Google Scholar
    • Export Citation
  • 51

    Southwick WORobinson RA: Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg Am 39:6316441957

    • Search Google Scholar
    • Export Citation
  • 52

    Thongtrangan IBalabhadra RSLe HPark JKim DH: Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection. Neurosurg Focus 15:5E82003

    • Search Google Scholar
    • Export Citation
  • 53

    Toth JMAn HSLim THRan YWeiss NGLundberg WR: Evaluation of porous biphasic calcium phosphate ceramics for anterior cervical interbody fusion in a caprine model. Spine 20:220322101995

    • Search Google Scholar
    • Export Citation
  • 54

    Wang JCHart RAEmery SEBohlman HH: Graft migration or displacement after multilevel cervical corpectomy and strut grafting. Spine 28:101610212003

    • Search Google Scholar
    • Export Citation
  • 55

    Zdeblick TABohlman HH: Cervical kyphosis and myelopathy. Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am 71:1701821989

    • Search Google Scholar
    • Export Citation
  • 56

    Zdeblick TADucker TB: The use of freeze-dried allograft bone for anterior cervical fusions. Spine 16:7267291991

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