Biomechanical comparison of expandable cages for vertebral body replacement in the cervical 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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Our first experience with cervical expandable cage for vertebral body reconstruction

Romanian Neurosurgery ◽

10.1515/romneu-2016-0006 ◽

2016 ◽

Vol 30 (1) ◽

pp. 41-46

Author(s):

A. Chiriac ◽

Z. Faiyad ◽

C. Popescu ◽

B. Costachescu ◽

I. Poeata

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Cervical Spondylotic Myelopathy ◽

Surgical Procedure ◽

Expandable Cage ◽

Thoracic Level ◽

Expandable Cages ◽

Cervical Vertebral Body

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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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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Acrylic Stabilization of the Cervical Spine for Neoplastic Disease: Evolution of a Technique for Vertebral Body Replacement

Neurosurgery ◽

10.1227/00006123-198307000-00004 ◽

1983 ◽

Vol 13 (1) ◽

pp. 23-29 ◽

Cited By ~ 16

Author(s):

William M. Chadduck ◽

Warren C. Boop

Keyword(s):

Cervical Spine ◽

Cancer Patients ◽

Vertebral Body ◽

Cervical Spinal Cord ◽

Vertebral Body Replacement ◽

Neoplastic Disease ◽

Disease Evolution ◽

Pin Fixation ◽

Progression Of Disease ◽

Vertebral Bodies

Abstract The resection of collapsed cervical vertebral bodies affected by malignant lytic lesions often requires innovative methods for stabilization. Over the years, immediate stabilization of the cervical spine has been achieved with acrylic bridges, preformed metallic placement bodies, fibular strut grafts, and other aids. Because acrylic bonds poorly to adjacent bony structures, techniques to assure the adequate fixation of an acrylic bridge between resected vertebral bodies are needed. The possible progression of disease in adjacent bone prompts us to maximize the amount of internal fixation with rods or pins to assure stability. Lasting stability has become more important as the longevity of cancer patients has been increased by multimodality therapy. We report our technique for treating cancer patients with acrylic and pin fixation of the cervical spine after vertebral body excision by the anterior route. Certain modifications of the technique may have advantages over previously reported procedures. Our series of six cases demonstrates the evolution of a technique that allows relatively rapid and easy decompression of the cervical spinal cord and provides immediate stability of the cervical spine. Our indications and contraindications for this procedure are also discussed.

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Vertebral Body Replacement with Alumina Ceramic Prosthesis for Multiple Myeloma of the Cervical Spine: A Case Report.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.39.1125 ◽

1991 ◽

Vol 39 (3) ◽

pp. 1125-1127

Author(s):

Ayumu Terada ◽

Takanori Imakiire ◽

Haruo Fujii ◽

Norio Morimoto

Keyword(s):

Multiple Myeloma ◽

Case Report ◽

Cervical Spine ◽

Vertebral Body ◽

Alumina Ceramic ◽

Vertebral Body Replacement

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Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation

Operative Neurosurgery ◽

10.1093/ons/opaa296 ◽

2020 ◽

Vol 20 (1) ◽

pp. 109-118 ◽

Cited By ~ 1

Author(s):

Natan Yusupov ◽

Sebastian Siller ◽

Johann Hofereiter ◽

Heinrich Karl Boehm ◽

Manuel Fuetsch ◽

...

Keyword(s):

Cervical Spine ◽

Vertebral Body ◽

Sagittal Profile ◽

Vertebral Body Replacement ◽

Radiological Evaluation ◽

Titanium Cage ◽

Single Level ◽

Anterior Corpectomy ◽

Expandable Titanium Cage

Abstract BACKGROUND Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. OBJECTIVE To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. METHODS Between 2011 and 2017, 40 patients underwent a single-level (N = 32) or 2-level (N = 8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. RESULTS Mean last follow-up was 14.8 ± 7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (>1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. CONCLUSION Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.

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