Preliminary Surgical Result of Cervical Spine Reconstruction with a Dynamic Plate and Titanium Mesh Cage

  • Chung, Dae-Yeong (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Cho, Dae-Chul (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Lee, Sun-Ho (Department of Neurosurgery, School of Medicine, Kyungpook National University) ;
  • Sung, Joo-Kyung (Department of Neurosurgery, School of Medicine, Kyungpook National University)
  • Published : 2007.02.28

Abstract

Objective : The objective of this study was to validate the effects of a titanium mesh cage and dynamic plating in anterior cervical stabilization after corpectomy. Methods : A retrospective study was performed on 31 consecutive patients, who underwent anterior cervical reconstruction with a titanium mesh cage and dynamic plating, from March 2004 to February 2006. Twenty-four patients had 1-level and 7 had 2-level corpectomies. Ten patients underwent surgery with a cage of 10-mm diameter and 21 with 13-mm diameter. Neurological status and outcomes were assessed according to Odom's criteria. Sagittal angle, coronal angle, settling ratio, sagittal displacement, and cervical lordosis were used to evaluate the radiological outcomes. Results : In overall, 26 [83.9%] of 31 showed excellent or good outcomes. Thirteen percent [4 cases] of the patients developed surgical complications, such as hoarseness, transient dysphagia, or nerve root palsy. Seven [22.6%] patients had reconstruction failure:5 [20.8%] in the 1-level corpectomy group and 2 [28.5%] in the 2-level corpectomy group. Revisions were required in 2 patients with plate pullout due to significant instability. However, none of 5 patients who demonstrated cage displacement or screw pullout, underwent a revision. Radiographs revealed bony consolidation in 96.3% of the patients, including 6 patients with implantation failure during the follow-up period. Conclusion : Based on our preliminary results, the titanium mesh cage and dynamic plating was effective for cervical reconstruction after corpectomy. The anterior cervical reconstruction performed with dynamic plates is considered to reduce stress shielding and greater graft compression that is afforded by the unique plate design.

Keywords

References

  1. Barnes B, Haid RW, Rodts GE, Subach BR, Kaiser M : Early results using the Atlantis anterior cervical plate system. Neurosurg Focus 12 : E13, 2002
  2. Bose B : Anterior cervical arthrodesis using DOC dynamic stabilization implant for improvement in sagittal angulation and controlled settling. J Neurosurg (Suppl 1) 98 : 8-13, 2003 https://doi.org/10.3171/jns.2003.98.1.0008
  3. Caspar W, Geisler FH, Pitzen T, Johnson TA : Anterior cervical plate stabilization in one and two-level degenerative disease : overtreatment or benefit? J Spinal Disord 11 : 1-11, 1998
  4. Chagas H, Domingues F, Aversa A, Vidal Fonseca AL, de Souza JM : Cervical spondylotic myelopathy : 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol (Suppl 1) 64 : 30-35, 2005 https://doi.org/10.1016/j.surneu.2005.02.016
  5. Cheng NS, Lau PY, Sun LK, Wong NM : Fusion rate of anterior cervical plating after corpectomy. J Orthop Surg (Hong Kong) 13 : 223-227, 2005 https://doi.org/10.1177/230949900501300302
  6. Chuang HC, Cho DY, Chang CS, Lee WY, Jung-Chung C, Lee HC, et al : Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy. Surg Neurol 65 : 464-471, 2006 https://doi.org/10.1016/j.surneu.2005.12.021
  7. Connolly PJ, Esses SI, Kostuik JP : Anterior cervical fusion : outcome analysis of patients fused with and without anterior cervical plates. J Spinal Disord 9 : 202-206, 1996
  8. Das K, Couldwell WT, Sava G, Taddonio RF : Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. J Neurosurg (Suppl 1) 94 : 174-178, 2001
  9. Daubs MD : Early failures following cervical corpectomy reconstruction with titanium mesh cages and anterior plating. Spine 30 : 1402-1406, 2005 https://doi.org/10.1097/01.brs.0000166526.78058.3c
  10. DiAngelo DJ, Foley KT, Vossel KA, Rampersaud YR, Jansen TH : Anterior cervical plating reverses load transfer through multilevel strutgrafts. Spine 25 : 783-795, 2000 https://doi.org/10.1097/00007632-200004010-00005
  11. Dorai Z, Morgan H, Coimbra C : Titanium cage reconstruction after cervical corpectomy. J Neurosurg (Suppl 1) 99 : 3-7, 2003 https://doi.org/10.3171/jns.2003.99.1.0003
  12. Epstein NE : The Management of One-Level Anterior Cervical Corpectomy with Fusion Using Atlantis Hybrid Plates : Preliminary Experience. J Spinal Disord Tech 13 : 324-328, 2000 https://doi.org/10.1097/00002517-200008000-00009
  13. Epstein NE : Anterior approaches to cervical spondylosis and ossification of the posterior longitudinal ligament : review of operative technique and assessment of 65 multilevel circumferential procedures. Surg Neurol 55 : 313-324, 2001 https://doi.org/10.1016/S0090-3019(01)00464-5
  14. Epstein NE : Anterior cervical dynamic ABC plating with single level corpectomy and fusion in forty-two patients. Spinal Cord 41 : 153-158, 2003 https://doi.org/10.1038/sj.sc.3101418
  15. Hee HT, Majd ME, Holt RT, Whitecloud TS 3rd, Pienkowski D : Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord Tech 16 : 1-8, 2003 https://doi.org/10.1097/00024720-200302000-00001
  16. Kanayama M, Hashimoto T, Shigenobu K, Oha F, Ishida T, Yamane S : Pitfalls of anterior cervical fusion using titanium mesh and local autograft. J Spinal Disord Tech 16 : 513-518, 2003 https://doi.org/10.1097/00024720-200312000-00005
  17. Liu JK, Apfelbaum RI, Schmidt MH : Surgical management of cervical spinal metastasis : anterior reconstruction and stabilization techniques. Neurosurg Clin N Am 15 : 413-424, 2004 https://doi.org/10.1016/j.nec.2004.04.005
  18. Majd ME, Vadhva M, Holt RT : Anterior cervical reconstruction using titanium cages with anterior plating. Spine 24 : 1604-1610, 1999 https://doi.org/10.1097/00007632-199908010-00016
  19. Martin GJ, Haid RW, MacMillan M, Rodts GE Jr, Berkman R : Anterior cervical discectomy with freeze-dried fibula allograft. Spine 24 : 852-859, 1999 https://doi.org/10.1097/00007632-199905010-00004
  20. McAfee PC : Interbody fusion cages in reconstructive operations of the spine. J Bone Joint Surg (Am) 81 : 859-880, 1999 https://doi.org/10.2106/00004623-199906000-00014
  21. Nakase H, Park YS, Kimura H, Sakaki T, Morimoto T : Complications and Long-Term Follow-Up Results in Titanium Mesh Cage Reconstruction After Cervical Corpectomy. J Spinal Disord Tech 19 : 353-357, 2006 https://doi.org/10.1097/01.bsd.0000210113.09521.aa
  22. Narotam PK, Pauley SM, McGinn GJ : Titanium mesh cages for cervical spine stabilization after corpectomy : a clinical and radiological study. J Neurosurg (Suppl 2) 99 : 172-180, 2003
  23. Reidy D, Finkelstein J, Nagpurkar A, Mousavi P, Whyne C : Cervical spine loading characteristics in a cadaveric C5 corpectomy model using a static and dynamic plate. J Spinal Disord Tech 17 : 117-122, 2004 https://doi.org/10.1097/00024720-200404000-00008
  24. Rieger A, Holz C, Marx T, Sanchin L, Menzel M : Vertebral autograft used as bone transplant for anterior cervical corpectomy : technical note. Neurosurgery 52 : 449-453, 2003 https://doi.org/10.1227/01.NEU.0000043815.31251.5B
  25. Sasso RC, Ruggiero RA Jr, Reilly TM, Hall PV : Early reconstruction failures after multilevel cervical corpectomy. Spine 28 : 140-142, 2003 https://doi.org/10.1097/00007632-200301150-00009
  26. Summers BN, Eisenstein SM : Donor site pain from the ilium. A complication of lumbar spine fusion. J Bone Joint Surg 71B : 677-680, 1989
  27. Thalgott JS, Xiongsheng C, Giuffre JM : Single stage anterior cervical reconstruction with titanium mesh cages, local bone graft, and anterior plating. Spine J 3 : 294-300, 2003 https://doi.org/10.1016/S1529-9430(02)00588-0
  28. Zhang HY, Thongtrangan I, Le H, Park J, Kim DH : Expandable Cage for Cervical Spine Reconstruction. J Korean Neurosurg Soc 38 : 435-441, 2005