Our first experience with cervical expandable cage for vertebral body reconstruction

Abstract Vertebral body reconstruction after corpectomy using expandable cage has become a common surgical procedure especially at thoracic level. The recent published papers describe the successful use of expandable cages for cervical vertebral body reconstruction. In this paper we present our first experience with expandable cervical cage in the reconstruction of the cervical spine in a patient with cervical spondylotic myelopathy (CSM)

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Use of a nano-hydroxyapatite/polyamide composite in anterior cervical subtotal corpectomy and fusion

Materials Express ◽

10.1166/mex.2021.2050 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1491-1496

Author(s):

Xiaojiang Li ◽

Xudong Zhang ◽

Shanshan Dong ◽

Haijun Li ◽

Chunlan Wang ◽

...

Keyword(s):

Bone Graft ◽

Vertebral Body ◽

Cervical Spondylotic Myelopathy ◽

Interbody Fusion ◽

Japanese Orthopaedic Association ◽

Fusion Rate ◽

Graft Material ◽

Improvement Rate ◽

Fusion Surgery ◽

Cervical Vertebral Body

This study aimed to explore the safety and efficacy of using nano-hydroxyapatite/polyamide (N-HA/PA) composite in anterior cervical vertebral body subtotal corpectomy and interbody fusion. Total 50 patients with cervical spondylotic myelopathy were enrolled to undergo anterior cervical spondylectomy. Bone graft pedicles were compounded with N-HA/PA and intervertebral body fusion was performed. Study outcomes included surgical efficacy and the degree of fusion. Patients in whom vertebral body fusion was performed with N-HA/PA composite pedicles had significantly improved symptoms. The postoperative Japanese Orthopaedic Association scores increased to 18.56±4.37 from 11.37±3.52, reflecting an improvement rate of 87.3%. The composite pedicle fusion rate was 96.4%. Therefore, N-HA/PA composite pedicle as a bone graft material in fusion surgery provides significant therapeutic efficacy. Moreover, the composite pedicle fusion rate is high, making it ideal for anterior cervical vertebral body subtotal corpectomy and fusion.

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Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection

Neurosurgical FOCUS ◽

10.3171/foc.2003.15.5.8 ◽

2003 ◽

Vol 15 (5) ◽

pp. 1-6 ◽

Cited By ~ 37

Author(s):

Issada Thongtrangan ◽

Raju S. V. Balabhadra ◽

Hoang Le ◽

Jon Park ◽

Daniel H. Kim

Keyword(s):

Vertebral Body ◽

Tumor Resection ◽

Anterior Column ◽

Vertebral Body Replacement ◽

Spinal Tumors ◽

Wide Resection ◽

Primary Tumors ◽

Expandable Cage ◽

Expandable Cages

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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Stress Changes in Intervertebral Discs of the Cervical Spine Due to Partial Discectomies and Fusion

Journal of Biomechanical Engineering ◽

10.1115/1.3118763 ◽

2009 ◽

Vol 131 (5) ◽

Cited By ~ 17

Author(s):

Abraham Tchako ◽

Ali M. Sadegh

Keyword(s):

Cervical Spine ◽

Bone Graft ◽

Vertebral Body ◽

Surgical Procedure ◽

Donor Site ◽

Compressive Force ◽

High Rate ◽

Flexion Extension ◽

Stress Changes ◽

Autologous Bone

Spine discectomy and fusion is a widely used surgical procedure to correct irreversible degenerative diseases and injuries to the intervertebral disk. The surgical procedure involves the removal of the damage disk material, the decortication of the fusion site, and the placement of the bone graft. Fusion is believed to generate additional stresses in the neighboring disks, which can subsequently lead to new disk degeneration and re-operation. The autologous bone has proven to be the best material for the fusion. However, the autologous bone has three major disadvantages: the high rate of donor site morbidity, the limited and sometimes poor quality of the amounts of bone available, and the extra operative time needed for harvest. For these reasons this study is undertaken to estimate the optimum amount of bone graft needed for a discectomy and correlate it to the change in stress in adjacent levels. A detailed and validated 3D finite element model of the complete human cervical spine (C1-T1) was altered to simulate segmental full and partial discectomies. One full fusion (bone graft occupies about 90% of the vertebral body) and seven partial fusions (bone graft occupies about 10%, 20%, 30%, 40%, 50%, 65%, and 75% of the vertebral body) were simulated at each of the four mid- and lower single levels of the cervical spine and the relationship between the change in stresses in the adjacent levels and the bone graft size (area) was studied. The changes in stress were compared with the previously obtained results of the unfused models. The fused and unfused models were preloaded with a 73.6 N compressive force representing the weight of the head and with a 1.5 Nm physiological moment in flexion, extension, lateral bending, and axial rotation. More than 132 cases were analyzed. The results showed that the necessary amount of bone graft needed for discectomy depends on the cervical disk level to be fused and varies between 30% and 75% of the disk area. The results also suggested that there is a threshold size of the bone graft area, before and/or after which, the long-term effects of the change in stresses in adjacent disks are biomechanically consequential.

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Anterior cervical vertebral body resection and bone-grafting for benign and malignant tumors. A survey under the auspices of the Cervical Spine Research Society.

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-197961020-00015 ◽

1979 ◽

Vol 61 (2) ◽

pp. 251-253 ◽

Cited By ~ 40

Author(s):

J W Fielding ◽

R N Pyle ◽

V G Fietti

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Bone Grafting ◽

Malignant Tumors ◽

Research Society ◽

Spine Research ◽

Cervical Vertebral Body

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Comparative study of expandable cage with integrated plate versus non expandable cage in cervical spine corpectomies

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i2.26515 ◽

2020 ◽

Vol 11 (2) ◽

pp. 86-88

Author(s):

Nakul Pahwa ◽

Suniti Kumar Saha ◽

Kaushik Roy ◽

Debajyoti Pathak ◽

Shuvayu Bandyopadhyay

Keyword(s):

Cervical Spine ◽

Similar Efficacy ◽

Plate Versus ◽

Expandable Cage ◽

Cage Group ◽

Cervical Plate ◽

Anterior Cervical Plate ◽

Expandable Cages

Background: The use of expandable cages in cervical spine has gained popularity over the last decade. They have been used in dorsal spine since long but were rarely used in cervical spine due to their high cost. Now, with more insight into their mechanics, many advantages have been noted over the fixed cages along with similar efficacy and with no added complications. Aims and Objectives: To study the benefits of expandable cage with incorporated anterior cervical plate over non expandable cage in cervical spine corpectomies. Materials and Methods: Ten cases of two level corpectomy were operated in each group and compared for intraoperative time, postoperative fusion rates and complications. Results: Intraoperative time was less in the expandable cage group. Fusion rates were comparable at 6 month follow up. No reported long term complication in both groups. Conclusion: Expandable cages are less frequently used in cervical spine due to their significantly higher cost but there are advantages such as decreased intraoperative manipulation and operative time, less damage to end plates and also useful in cases of poor bone quality.

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Adjacent-level vertebral body fractures after expandable cage reconstruction

Journal of Neurosurgery Spine ◽

10.3171/spi/2008/8/6/584 ◽

2008 ◽

Vol 8 (6) ◽

pp. 584-588 ◽

Cited By ~ 25

Author(s):

Dean Chou ◽

Daniel C. Lu ◽

Philip Weinstein ◽

Christopher P. Ames

Keyword(s):

Vertebral Body ◽

Spinal Column ◽

Fracture Pattern ◽

Coronal Plane ◽

Adjacent Level ◽

Vertebral Body Fracture ◽

Expandable Cage ◽

Vertebral Body Fractures ◽

Body Fracture ◽

Expandable Cages

✓Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. The forces that are used to expand these cages can be large, depending upon the mechanism of expansion. To the authors' knowledge, there have been no reports of adjacent-level vertebral body fracture after placement of expandable cages. The authors report 4 cases of adjacent-level vertebral body fractures after placement of expandable cages. This study found that the fracture pattern in the coronal plane was similar in all cases.

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Failure of an expandable cage-plate cervical vertebral body replacement: case report of a device related complication

Joint Diseases and Related Surgery ◽

10.5606/ehc.2017.55948 ◽

2017 ◽

Vol 28 (3) ◽

pp. 214-218

Author(s):

Klemens Trieb

Keyword(s):

Case Report ◽

Vertebral Body ◽

Vertebral Body Replacement ◽

Related Complication ◽

Expandable Cage ◽

Cervical Vertebral Body

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Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine

Journal of Orthopaedic Surgery ◽

10.1177/2309499019900472 ◽

2020 ◽

Vol 28 (1) ◽

pp. 230949901990047

Author(s):

Barbara Cappelletto ◽

Fabrizia Giorgiutti ◽

Massimo Balsano

Keyword(s):

Vertebral Body ◽

Primary Stability ◽

Clinical Results ◽

Kyphosis Angle ◽

Analog Scale ◽

Traumatic Injuries ◽

Expandable Cage ◽

Clinical Observations ◽

Anterior Support ◽

Expandable Cages

Purpose: For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. Methods: Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single ( n = 34), double ( n = 4), or triple ( n = 1) corpectomy. Pathologies were tumors ( n = 21), fractures, or deformities in traumatic injuries ( n = 14), degenerative pathology ( n = 2), and infection ( n = 2). Levels were cervical ( n = 10), thoracic ( n = 14), and lumbar ( n = 15). All patients were evaluated clinically and radiographically. Results: There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative ( p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. Conclusions: In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.

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