Titanium Cage-assisted Polymethylmethacrylate Reconstruction for Cervical Spinal Metastasis: Technical Note

2005 ◽  
Vol 56 (suppl_1) ◽  
pp. ONS-E207-ONS-E207 ◽  
Author(s):  
James K. Liu ◽  
William S. Rosenberg ◽  
Meic H. Schmidt
Keyword(s):  
Cervical Spine ◽  
Spinal Metastasis ◽  
Plate Fixation ◽  
Body Height ◽  
Tumor Resection ◽  
Reconstruction Technique ◽  
Titanium Cage ◽  
Postoperative Hematoma ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Abstract OBJECTIVE: Reconstruction and stabilization of the cervical spine after vertebrectomy is an important goal in the surgical management of spinal metastasis. The authors describe their reconstruction technique using a titanium cage-Silastic tube construct injected with polymethylmethacrylate (PMMA) augmented by an anterior cervical plate. The surgical results using this technique are reviewed. METHODS: Six patients ranging from 43 to 70 years of age underwent resection of metastatic tumor in the cervical spine followed by cage-assisted PMMA reconstruction of the anterior spinal column. The following reconstruction technique was performed. A Silastic tube is incised longitudinally and placed circumferentially around a titanium cage with the opening facing anteriorly. The cage-Silastic tube construct is carefully tapped into the corpectomy defect and filled with PMMA. The final construct is then augmented with anterior cervical plate fixation. RESULTS: Two patients required additional posterior stabilization with lateral mass screws and rods. All patients achieved immediate stabilization, restoration of vertebral body height and normal lordosis, and preservation of the ability to walk independently. Five patients experienced significant palliation of biomechanical neck pain. There were no complications of neurological worsening, postoperative hematoma, wound infection, subsidence, graft dislodgement, or construct failure during a follow-up period of 1 to 19 months (mean, 6.8 mo). CONCLUSION: Titanium cage-assisted PMMA reconstruction augmented with an anterior cervical plate is an effective means of reconstruction after tumor resection in patients with cervical spinal metastasis. The Silastic tube holds the PMMA within the cage and protects the spinal cord from potential thermal injury.

Biomechanical comparison of anterior cervical spine instrumentation techniques with and without supplemental posterior fusion after different corpectomy and discectomy combinations

2012 ◽  
Vol 16 (6) ◽  
pp. 579-584 ◽  
Author(s):  
Matthias Setzer ◽  
Mohamed Eleraky ◽  
Wesley M. Johnson ◽  
Kamran Aghayev ◽  
Nam D. Tran ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Axial Rotation ◽  
Optical Tracking ◽  
Posterior Fixation ◽  
Titanium Cage ◽  
Cervical Corpectomy ◽  
Intact Condition ◽  
Anterior Plating ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object The objective of this study was to compare the stiffness and range of motion (ROM) of 4 cervical spine constructs and the intact condition. The 4 constructs consisted of 3-level anterior cervical discectomy with anterior plating, 1-level discectomy and 1-level corpectomy with anterior plating, 2-level corpectomy with anterior plating, and 2-level corpectomy with anterior plating and posterior fixation. Methods Eight human cadaveric fresh-frozen cervical spines from C2–T2 were used. Three-dimensional motion analysis with an optical tracking device was used to determine motion following various reconstruction methods. The specimens were tested in the following conditions: 1) intact; 2) segmental construct with discectomies at C4–5, C5–6, and C6–7, with polyetheretherketone (PEEK) interbody cage and anterior plate; 3) segmental construct with discectomy at C6–7 and corpectomy of C-5, with PEEK interbody graft at the discectomy level and a titanium cage at the corpectomy level; 4) corpectomy at C-5 and C-6, with titanium cage and an anterior cervical plate; and 5) corpectomy at C-5 and C-6, with titanium cage and an anterior cervical plate, and posterior lateral mass screw-rod system from C-4 to C-7. All specimens underwent a pure moment application of 2 Nm with regards to flexion-extension, lateral bending, and axial rotation. Results In all tested motions the statistical comparison was significant between the intact condition and the 2-level corpectomy with anterior plating and posterior fixation construct. All other statistical comparisons between the instrumented constructs were not statistically significant except between the 3-level discectomy with anterior plating and the 2-level corpectomy with anterior plating in axial rotation. There were no statistically significant differences between the 1-level discectomy and 1-level corpectomy with anterior plating and the 2-level corpectomy with anterior plating in any tested motion. There was also no statistical significance between the 3-level discectomy with anterior plating and the 2-level corpectomy with anterior plating and posterior fixation. Conclusions This study demonstrates that segmental plate fixation (3-level discectomy) affords the same stiffness and ROM as circumferential fusion in 2-level cervical spine corpectomy in the immediate postoperative setting. This obviates the need for staged circumferential procedures for multilevel cervical spondylotic myelopathy. Given that the posterior segmental instrumentation confers significant stability to a multilevel cervical corpectomy, the surgeon should strongly consider the placement of segmental posterior instrumentation to significantly improve the overall stability of the fusion construct after a 2-level cervical corpectomy.

Does smoking have an impact on fusion rate in single-level anterior cervical discectomy and fusion with allograft and rigid plate fixation?

2013 ◽  
Vol 19 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Myles Luszczyk ◽  
Justin S. Smith ◽  
Jeffrey S. Fischgrund ◽  
Steven C. Ludwig ◽  
Rick C. Sasso ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Fusion Rate ◽  
Anterior Cervical Discectomy ◽  
Cervical Disc ◽  
Cervical Discectomy ◽  
Single Level ◽  
Significant Difference ◽  
Solid Fusion ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Although smoking has been shown to negatively affect fusion rates in patients undergoing multilevel fusions of the cervical and lumbar spine, the effect of smoking on fusion rates in patients undergoing single-level anterior cervical discectomy and fusion (ACDF) with allograft and plate fixation has yet to be thoroughly investigated. The objective of the present study was to address the effect of smoking on fusion rates in patients undergoing a 1-level ACDF with allograft and a locked anterior cervical plate. Methods This study is composed of patients from the control groups of 5 separate studies evaluating the use of an anterior cervical disc replacement to treat cervical radiculopathy. For each of the 5 studies the control group consisted of patients who underwent a 1-level ACDF with allograft and a locked cervical plate. The authors of the present study reviewed data obtained in a total of 573 patients; 156 patients were smokers and 417 were nonsmokers. A minimum follow-up period of 24 months was required for inclusion in this study. Fusion status was assessed by independent observers using lateral, neutral, and flexion/extension radiographs. Results An overall fusion rate of 91.4% was achieved in all 573 patients. A solid fusion was shown in 382 patients (91.6%) who were nonsmokers. Among patients who were smokers, 142 (91.0%) had radiographic evidence of a solid fusion. A 2-tailed Fisher exact test revealed a p value of 0.867, indicating no difference in the union rates between smokers and nonsmokers. Conclusions The authors found no statistically significant difference in fusion status between smokers and nonsmokers who underwent a single-level ACDF with allograft and a locked anterior cervical plate. Although the authors do not promote tobacco use, it appears that the use of allograft with a locked cervical plate in single-level ACDF among smokers produces similar fusion rates as it does in their nonsmoking counterparts.

In Vitro Comparison of a Translational Anterior Cervical Plate With a Constrained Anterior Cervical Plate

2001 ◽  
Author(s):  
Denis J. DiAngelo ◽  
Weiqiang Liu ◽  
Kristine M. Olney ◽  
Kevin T. Foley
Keyword(s):  
Cervical Spine ◽  
Cervical Spondylosis ◽  
Load Transfer ◽  
Multi Level ◽  
Cervical Plate ◽  
Degenerative Disorder ◽  
Anterior Cervical Plate ◽  
Cervical Plating ◽  
In Vitro Comparison

Abstract Cervical spondylosis is the most common degenerative disorder affecting the cervical spine and is often treated surgically to prevent further neurological deterioration. However, clinical experience has shown that anterior cervical plating does not prevent construct failure in multi-level cervical corpectomy (Vaccaro et al., 1998). We have previously shown that anterior cervical plating reverses the load transfer through multi-level strut-grafts and may promote pistoning of these grafts (DiAngelo et al., 2000). The design of the anterior cervical plate (ACP) may contribute to this phenomenon. The purpose of this study was to compare the graft loading mechanics of two different anterior cervical plating systems; one with a constrained plate-screw interface versus another with a semi-constrained, translational plate-screw interface.

Early Failure of Long Segment Anterior Cervical Plate Fixation

1998 ◽  
Vol 11 (5) ◽  
pp. 410???415 ◽  
Author(s):  
Alexander R. Vaccaro ◽  
Stephen P. Falatyn ◽  
Gaetano J. Scuderi ◽  
Frank J. Eismont ◽  
Robert A. McGuire ◽  
...  
Keyword(s):  
Plate Fixation ◽  
Early Failure ◽  
Cervical Plate ◽  
Anterior Cervical Plate

A Case of Hypopharyngeal Perforation after Anterior Cervical Plate Fixation

2018 ◽  
Vol 111 (6) ◽  
pp. 415-419
Author(s):  
Kouhei Mihashi ◽  
Eiji Takeuchi ◽  
Kazunori Fujiwara ◽  
Hiromi Takeuchi
Keyword(s):  
Plate Fixation ◽  
Hypopharyngeal Perforation ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Effectiveness of cemented rescue screws for anterior cervical plate fixation

2006 ◽  
Vol 4 (1) ◽  
pp. 60-63 ◽  
Author(s):  
Tobias Rainer Pitzen ◽  
Jörg Drumm ◽  
Bernhard Bruchmann ◽  
Dragos Doru Barbier ◽  
Wolf-Ingo Steudel
Keyword(s):  
Bone Cement ◽  
Sagittal Plane ◽  
Plate Fixation ◽  
Peak Torque ◽  
Fixation Strength ◽  
Mineral Density ◽  
Pullout Force ◽  
The Mean ◽  
Cervical Plate ◽  
Anterior Cervical Plate

Object Among the various ways to optimize the fixation of bone implants is to use bone cement, for example, in a total hip prosthesis. No data exist, however, concerning the effectiveness of cemented rescue screws for anterior cervical plate fixation. The aim of this study was to investigate whether cemented rescue screws increase fixation strength in comparison with uncemented standard screws. Methods Six cervical spine segments (C4–7) were explanted during routine autopsy studies from fresh human cadavers. Bone mineral density (BMD) was measured for each vertebral body (VB) using quantitative computerized tomography scanning, and 24 VBs were dissected from the segments. Two initial pilot holes were drilled into each VB parallel to the sagittal plane. Based on their BMD, the specimens were assigned to one of two groups in which torque and pullout force were tested. The test was begun with standard screws and was repeated with cannulated slotted rescue screws into which bone cement was injected. The mean values of peak torque and pullout forces resulting from the left and right measurements were used for statistical analysis. A t-test was performed to determine the effect of screw type on peak torque and pullout force. Moment correlation coefficients were calculated to determine the effect of BMD on peak torque and pullout force for each type of screw. The mean insertional peak torque was 67.1 N/cm for the standard screw and 102.6 N/cm for the cemented screw (p < 0.05). The mean pullout force was 526.9 N for standard osteoporosis screws and 531.5 N for cemented screws (p > 0.05). The effect of increased holding strength as measured by peak torque and pullout force was more pronounced in the presence of low bone density. Conclusions Cemented rescue screws that have been inserted into a fatigued pilot hole in the cervical VB strengthen the screw–bone interface compared with the strength initially conferred by a standard screw.

Cervical spinal metastasis: anterior reconstruction and stabilization techniques after tumor resection

2003 ◽  
Vol 15 (5) ◽  
pp. 1-7 ◽  
Author(s):  
James K. Liu ◽  
Ronald I. Apfelbaum ◽  
Bennie W. Chiles ◽  
Meic H. Schmidt
Keyword(s):  
Cervical Spine ◽  
Spinal Metastasis ◽  
Posterior Instrumentation ◽  
Tumor Resection ◽  
Spinal Metastases ◽  
Metastatic Tumor ◽  
Subaxial Cervical Spine ◽  
Bone Autograft ◽  
Anterior Reconstruction ◽  
Anterior Cervical Corpectomy

Object In a review of the literature, the authors provide an overview of various techniques that have evolved for reconstruction and stabilization after resection for metastatic disease in the subaxial cervical spine. Methods Reconstruction and stabilization of the cervical spine after vertebral body (VB) resection for metastatic tumor is an important goal in the surgical management of spinal metastasis. Generally, the VB defect is reconstructed with bone autograft or allograft, polymethylmethacrylate (PMMA), interbody spacers, and/or cages. In cases of PMMA-assisted reconstruction, internal devices are used to augment the fixation of PMMA. Stabilization is then achieved with anterior instrumentation, usually an anterior cervical locking plate. In some cases, posterior instrumentation may be necessary to supplement the anterior construct. Conclusions Anterior cervical corpectomy followed by reconstruction and stabilization is an effective strategy in the management of spinal metastases in patients.

scholarly journals The Cervical Spine Study Group anterior cervical plate nomenclature

2002 ◽  
Vol 12 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Regis W. Haid ◽  
Kevin T. Foley ◽  
Gerald E. Rodts ◽  
Bryan Barnes
Keyword(s):  
Cervical Spine ◽  
Classification System ◽  
Study Group ◽  
Review Of The Literature ◽  
New Classification ◽  
Plate Interface ◽  
Translational Movement ◽  
Laboratory Investigations ◽  
Cervical Plate ◽  
Anterior Cervical Plate

The authors review historical and biomechanical aspects of anterior cervical plate (ACP) systems. They propose a novel classification system for ACPs based on the biomechanical and graft-loading properties of these systems. A retrospective review of the literature comprising both clinical and laboratory investigations regarding the ACP system was undertaken. Comparison of each system is considered in the context of the biomechanical attributes and graft-loading properties of each type of plate. Salient characteristics reviewed include restriction of screw backout, screw-angle variability, and mobility at the screw–plate interface. A new classification system for ACPs is proposed that primarily considers the ability of the construct to restrict screw backout, as well as the properties of the plate–screw interface—that is, the capacity for rotational or translational movement. A new classification system is presented that provides unified, biomechanically descriptive nomenclature. Using this nomenclature, the ACP devices currently available and those developed in the future can be uniformly categorized.

scholarly journals Anterior Cervical Spine Fusion with ORION Anterior Cervical Plate for Dislocation-Fracture of Cervical spine.

2000 ◽  
Vol 49 (3) ◽  
pp. 787-791
Author(s):  
Koichi Adachi ◽  
Hiroaki Konishi ◽  
Shinichiro Hara ◽  
Ryoichi Takasuga ◽  
Hironori Hara ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Fusion ◽  
Cervical Plate ◽  
Cervical Spine Fusion ◽  
Anterior Cervical Plate

scholarly journals The Choice of the Best Surgery After Single Level Anterior Cervical Spine Discectomy: A Systematic Review

2012 ◽  
Vol 6 (1) ◽  
pp. 121-128 ◽  
Author(s):  
Ricardo Vieira Botelho ◽  
Yuri dos Santos Buscariolli ◽  
Marcus Vinicius Flores de Barros Vasconcelos Fernandes Serra ◽  
Marcia Nogueira Pires Bellini ◽  
Wanderley Marques Bernardo
Keyword(s):  
Randomized Trials ◽  
Plate Fixation ◽  
Clinical Results ◽  
Limited Evidence ◽  
Moderate Evidence ◽  
Intervertebral Disc Height ◽  
Central Registry ◽  
Cervical Plate ◽  
Intervertebral Cage ◽  
Anterior Cervical Plate

Background: The anterior cervical discectomy (ACD) is often used to treat spinal cord and nerve root compressions and the frequent use of interbody fusion (ACDF) has popularized it as a common practice associated or not with cages or plates for maintaining the intervertebral disc height. Objective: The aim of this study is to clarify the effectiveness of ACD compared with ACDF, with or without the use of anterior cervical spacer (Cage) or instrumentation with plate fixation (ACDFI). Methods: randomized controlled trials or quasi-randomized trials were selected for analysis in one segmental level. The comparison criteria were the rates of success and failure with surgery (Odom’s’ criteria), fusion rates and kyphosis rates. Electronic search was made in the MEDLINE database (Pubmed), in the Central Registry of randomized trials of Cochrane database and EMBASE. Results: Seven studies were selected for analysis. Conclusion: Implications for practice: There is moderate evidence that clinical results of ACD and ACDF are not significant different. There is moderate evidence that addition of intervertebral cage enhance clinical results.There is moderate evidence that anterior cervical plate does not change the clinical results of ACD. There is moderate evidence that ACD produce more segmental kyphosis than ACDF and ACDFI, with use of cage or plate.There is moderate evidence that ACD produce lower rate of fusion than ACDF and than the cages. There is limited evidence of the lower capacity of PMMA to produce fusion. There is limited evidence that fused patients have better outcome than non fused patients.

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