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

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

Brain and Spine ◽

10.1016/j.bas.2021.100421 ◽

2021 ◽

Vol 1 ◽

pp. 100421

Author(s):

S. Motov ◽

B. Stemmer ◽

B. Sommer ◽

M.N. Bonk ◽

C. Wolfert ◽

...

Keyword(s):

Vertebral Body ◽

Deformity Correction ◽

Vertebral Body Replacement ◽

Sagittal Deformity ◽

Expandable Cages

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Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures

European Spine Journal ◽

10.1007/s00586-021-07044-3 ◽

2021 ◽

Author(s):

Maximilian Schwendner ◽

Stefan Motov ◽

Yu-Mi Ryang ◽

Bernhard Meyer ◽

Sandro M. Krieg

Keyword(s):

Vertebral Body ◽

Thoracolumbar Spine ◽

Osteoporotic Fractures ◽

The Elderly ◽

Vertebral Body Replacement ◽

Inclusion Criteria ◽

Dorsal Instrumentation ◽

The Individual

Abstract Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.

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Anterior column reconstruction of the thoracolumbar spine with a new modular PEEK vertebral body replacement device: retrospective clinical and radiologic cohort analysis of 48 cases with 1.7-years follow-up

European Spine Journal ◽

10.1007/s00586-020-06464-x ◽

2020 ◽

Vol 29 (12) ◽

pp. 3194-3202

Author(s):

M. C. Deml ◽

C. A. Mazuret Sepulveda ◽

C. E. Albers ◽

S. Hoppe ◽

S. F. Bigdon ◽

...

Keyword(s):

Vertebral Body ◽

Cohort Analysis ◽

Thoracolumbar Spine ◽

Anterior Column ◽

Vertebral Body Replacement ◽

Anterior Column Reconstruction ◽

Replacement Device

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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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