Sagittal deformity correction with expandable cages with large endplates for thoracolumbar vertebral body replacement

Object The authors report their clinical experience with expandable cages used to stabilize the spine after verte-brectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR). Methods Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20°. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage. Conclusions The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.

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Biomechanical Comparison of Expandable Cages for Vertebral Body Replacement in the Thoracolumbar Spine

Spine ◽

10.1097/01.brs.0000129895.90939.1e ◽

2004 ◽

Vol 29 (13) ◽

pp. 1413-1419 ◽

Cited By ~ 69

Author(s):

Robert Pflugmacher ◽

Philipp Schleicher ◽

Jan Schaefer ◽

Matti Scholz ◽

Kathrin Ludwig ◽

...

Keyword(s):

Vertebral Body ◽

Thoracolumbar Spine ◽

Vertebral Body Replacement ◽

Biomechanical Comparison ◽

Expandable Cages

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VERTEBRAL BODY REPLACEMENT SYSTEMS WITH EXPANDABLE CAGES IN THE TREATMENT OF VARIOUS SPINAL PATHOLOGIES

Neurosurgery ◽

10.1227/01.neu.0000325260.00628.dc ◽

2008 ◽

Vol 63 (3) ◽

pp. 537-545 ◽

Cited By ~ 54

Author(s):

Mark P. Arts ◽

Wilco C. Peul

Keyword(s):

Vertebral Body ◽

Case Series ◽

Clinical Results ◽

Herniated Disc ◽

Vertebral Body Replacement ◽

Traumatic Fracture ◽

Circumferential Fusion ◽

Favorable Clinical Outcome ◽

Reoperation Rates ◽

Expandable Cages

ABSTRACT OBJECTIVE Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications. METHODS Sixty patients underwent single or multilevel corpectomy for degenerative stenosis (13 patients), herniated disc (7 patients), deformity (14 patients), traumatic fracture (3 patients), infection (1 patient), or tumor (22 patients). Six different expandable vertebral body systems were used in the cervical spine (41 patients), thoracic spine (15 patients), and lumbar spine (4 patients). All patients were evaluated clinically and radiographically. RESULTS Thirty-nine patients underwent single-level corpectomy, 18 patients underwent two-level corpectomy, and 3 patients underwent three-level corpectomy. Anterior reconstruction alone was performed in 30 patients; circumferential reconstruction was performed in 30 patients, 9 of whom underwent reconstruction through a posterior approach only. At the time of the final follow-up examination (mean, 9 mo), the Nurick grade improved significantly. Ninety-five percent of the patients maintained or improved their Frankel score and 67% had good clinical results. The regional angulation was corrected significantly (4.0 ± 9.0 degrees, P = 0.002), and the segment height increased significantly (3.5 ± 8.0 mm, P = 0.002). Bony fusion was achieved in 93% of the cases. Subsidence was documented in nearly half of the patients (1.4 ± 2.0 mm) and was reduced after circumferential fusion (0.9 ± 1.9 mm, P = 0.08). Eighteen patients (30%) had complications and 12 patients (20%) underwent revision surgery. CONCLUSION Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.

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Posterior approach for thoracolumbar corpectomies with expandable cage placement and circumferential arthrodesis: a multicenter case series of 67 patients

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine09956 ◽

2011 ◽

Vol 14 (3) ◽

pp. 388-397 ◽

Cited By ~ 22

Author(s):

Christoph P. Hofstetter ◽

Dean Chou ◽

C. Benjamin Newman ◽

Henry E. Aryan ◽

Federico P. Girardi ◽

...

Keyword(s):

Posterior Approach ◽

Spinal Injury ◽

Posterior Instrumentation ◽

Case Series ◽

Deformity Correction ◽

Neurological Function ◽

Single Stage ◽

Wide Range ◽

Sagittal Deformity ◽

Expandable Cages

Object The purpose of this multicenter trial was to investigate the outcome and durability of a single-stage thoracolumbar corpectomy using expandable cages via a posterior approach. Methods The authors conducted a retrospective chart review of 67 consecutive patients who underwent single-stage thoracolumbar corpectomies with circumferential reconstruction for pathological, traumatic, and osteomyelitic pathologies. Circumferential reconstruction was accomplished using expandable cages along with posterior instrumentation and fusion. Correction of the sagittal deformity, the American Spinal Injury Association score, and complications were recorded. Results Single-stage thoracolumbar corpectomies resulted in an average sagittal deformity correction of 6.2° at a mean follow-period of 20.5 months. At the last follow-up, a fusion rate of 68% was observed for traumatic and osteomyelitic fractures. Approximately one-half of the patients remained neurologically stable. Improvement in neurological function occurred in 23 patients (38%), whereas 7 patients (11%) suffered from a decrease in lower-extremity motor function. The deterioration in neurological function was due to progression of metastatic disease in 5 patients. Five constructs (7%) failed—3 of which had been placed for traumatic fractures, 1 for a pathological fracture, and 1 for an osteomyelitic fracture. Other complications included epidural hematomas in 3 patients and pleural effusions in 2. Conclusions Single-stage posterior corpectomy and circumferential reconstruction were performed at multiple centers with a consistent outcome over a wide range of pathologies. Correction of the sagittal deformity was sustained, and the neurological outcome was good in the majority of patients; however, 18% of acute traumatic fractures required revision of the construct.

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Biomechanical comparison of expandable cages for vertebral body replacement in the cervical spine

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.1.0091 ◽

2003 ◽

Vol 99 (1) ◽

pp. 91-97 ◽

Cited By ~ 7

Author(s):

Frank Kandziora ◽

Robert Pflugmacher ◽

Jan Schaefer ◽

Matti Scholz ◽

Kathrin Ludwig ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Vertebral Body Replacement ◽

Biomechanical Comparison ◽

Expandable Cages

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Flexible device for vertebral body replacement

Journal of Biomedical Engineering ◽

10.1016/0141-5425(89)90119-2 ◽

1989 ◽

Vol 11 (2) ◽

pp. 113-117 ◽

Cited By ~ 1

Author(s):

J.A. Main ◽

M.E. Wells ◽

D.M. Spengler ◽

A.M. Strauss ◽

T.S. Keller

Keyword(s):

Vertebral Body ◽

Vertebral Body Replacement ◽

Flexible Device

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Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3662 ◽

2020 ◽

Vol 8 (B) ◽

pp. 76-80

Author(s):

Moneer K. Faraj ◽

Bassam Mahmood Flamerz Arkawazi ◽

Hazim Moojid Abbas ◽

Zaid Al-Attar

Keyword(s):

Functional Outcome ◽

Vertebral Body ◽

Karnofsky Performance Status ◽

Performance Status ◽

Spinal Tuberculosis ◽

Vertebral Body Replacement ◽

Spinal Tumors ◽

Karnofsky Performance Status Scale ◽

Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

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