====== Cervical interbody stand-alone cage ====== {{ ::interbody_cage.jpg?200|}} {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1nASi37tjavWgzyAkq8VRjjv9HL9A_f2k3t5t9dIPBw30JqsO9/?limit=15&utm_campaign=pubmed-2&fc=20230918074948}} ---- ---- A cervical [[interbody stand-alone cage]], often referred to as a [[cervical interbody cage]] or simply a [[cervical cage]], is a [[medical device]] used in [[spinal surgery]] to treat conditions of the cervical spine (neck region). It is designed to be inserted between two adjacent [[cervical vertebra]]e to provide stability and promote fusion. Here's some essential information about cervical interbody stand-alone cages: ===== Purpose ===== [[Cervical cage]]s are used to treat various cervical spine conditions, including [[cervical degenerative disc disease]], [[cervical disc herniation]], [[cervical spinal stenosis]], and [[cervical degenerative spondylolisthesis]]. The cage's primary purpose is to restore the [[space]] between vertebrae, maintain proper alignment, and promote [[fusion]] of the adjacent vertebrae. ===== Material ===== These cages are typically made of [[biocompatible]] materials like [[titanium]] or [[polyetheretherketone]] (PEEK). These materials are chosen for their strength, compatibility with the body, and ability to integrate with the surrounding bone. ===== Design ===== Cervical cages come in various shapes and sizes, but they are generally designed to fit snugly between the vertebral bodies. Some common cage designs include rectangular, cylindrical, and wedge-shaped cages. The choice of design depends on the surgeon's preference and the patient's specific spinal condition. ===== Fusion Promotion ===== Cervical cages are often used in conjunction with [[bone graft]] material. A bone graft can be placed within the cage or around it. This promotes the fusion of the adjacent vertebrae over time, effectively stabilizing the spine. ===== Stand-Alone Feature ===== The term "stand-alone" implies that these cages can provide stability and promote fusion without the need for additional hardware such as plates or screws. However, in some cases, supplemental fixation may still be required to ensure proper stability and alignment. ===== Surgical Procedure ===== The surgical procedure to insert a cervical interbody cage see [[Anterior cervical discectomy]]. Bone graft material may be added before or after placing the cage. The incision is then closed, and the patient is monitored during the healing process. ===== Post-Operative Care ===== Patients who undergo [[cervical spine surgery]] with interbody cages often need a period of post-operative rehabilitation and may be required to wear a cervical collar for support. The fusion process can take several months, and the patient's progress is monitored through follow-up appointments and imaging studies. Cervical interbody stand-alone cages are just one of the many tools available to orthopedics and neurosurgeons for addressing cervical spine issues. The choice of surgical approach and implant depends on the patient's specific condition and the surgeon's assessment of the best treatment plan. ---- ===== Classification ===== [[Cervical interbody Zero-profile stand-alone cage]]. [[Cervical interbody stand-alone cage]] and [[anterior cervical plate]]. [[Expandable interbody cage]] ===== Materials ===== Graft (e.g. [[PEEK]], [[cadaver bone]], [[titanium cage]]...) and [[anterior cervical plate]] (optional, especially on single-level ACDF). ---- [[Autologous bone]] (usually from the iliac crest), non-autologous bone (cadaveric), bone substitutes (e.g. hydroxylapatite ((Senter HJ, Kortyna R, Kemp WR. Anterior Cervical Discectomy with Hydroxylapatite Fusion. Neurosurgery. 1989; 25:39–43))) or synthetics (e.g. PEEK or titanium cage) filled with an osteogenic material. Substitutes for autologous bone eliminate problems with the donor site but may have a higher rate of absorption. There were also cases of HIV transmission from cadaveric bone grafts in 1985, however, as a result of the heightened awareness of AIDS since that time together with significant improvements in antibody testing and careful screening of donors, no further cases have been reported. ---- Different [[interbody cage]]s are currently used for surgical reconstruction of the anterior and middle columns of the spine following [[anterior cervical corpectomy]]. However, subsidence and delayed union/nonunion associated with [[allograft]] and cage reconstruction are common [[complication]]s, which may require revision with instrumentation. Cages come in different shapes and sizes; some are cylinder-shaped and others box-shaped. Cages are placed (fit) into the spine between vertebrae. Usually, cages are made from bone, metal, plastic, or carbon fiber. Bone chips (autograft, allograft, other bone graft substitutes, or other bone growth-stimulating substances (e.g., demineralized bone matrix) may be packed into the cage. During the months after surgery, the hope is the cage will allow (enhance) fusion between the vertebrae below and above. Fusion increases spinal stability. Variations include the use of [[cervical cage]]s made of several materials instead of [[autologous bone]] and the use of cages with or without [[cervical plating]]. The stand-alone cervical cages (SAc) have the advantages of less surgical time, less bleeding, and less cervical tissue dissection, with a lesser ratio of postoperative dysphagia and quicker recovery ((Chen Y , Lü G , Wang B , Li L , Kuang L . A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J. 2016;25(7):2255–2262. doi:10.1007/s00586-016-4391-x )). ===== Devices ===== see https://thespinemarketgroup.com/category/acif/stand-alone/ Abudouaini et al. creatively designed an elastically deformable [[cervical]] [[implant]] to reduce the [[postoperative]] [[stress]] concentration. They aimed to investigate the biomechanical performance of this novel cervical implant and compare it with the commonly used cervical [[device]]s. A biomechanical test was conducted on twelve fresh-frozen human cadaveric cervical spines (C2-C7) and randomly divided into four groups according to implant types: the intact group, [[Cervical interbody zero-profile stand-alone cage]] (ACDF) group, the novel cervical implant group, and the [[Pretic-I]] [[artificial]] [[cervical disc]] (ACDR) group. An optical tracking system was used to evaluate the segmental range of motion (ROM) of the C4/C5, C5/C6, and C6/C7 segments, and a micro pressure sensor was used to record the maximum facet joint pressure (FJP), maximum intradiscal pressure (IDP) at the C4-5 and C6-7 segments. There were no significant differences in the ROM of adjacent segments between the groups. Compared with the intact group, the ACDR group essentially retained the ROM of the operated segment. The novel cervical implant decreased some ROM of the operated segment, but it was still significantly higher than in the fusion group; The maximum FJP and IDP at the adjacent segments in the ACDF group were significantly higher than those values in the other groups, and there were no differences in the other groups. While the newly developed elastically deformable cervical implant does not completely maintain [[ROM]] like the artificial cervical disc, it surpasses the fusion device with regard to biomechanical attributes. After further refinement, this novel implant may be suitable for patients who are prone to severe [[adjacent segment degeneration]] after [[fusion surgery]] but no indication for [[artificial]] [[cervical disc]] [[surgery]] ((Abudouaini H, Wu T, Meng Y, Ding C, Liu H, Beiyu W. Biomechanical properties of a novel cervical spine implant with elastic deformation: a cadaveric study. Front Bioeng Biotechnol. 2023 Aug 29;11:1214877. doi: 10.3389/fbioe.2023.1214877. PMID: 37711451; PMCID: PMC10497878.)). ---- Idys®-C ZP 3DTi (Clariance Spine) STALIF C FLX (Centinel Spine) Hexanium ACIF cage (SpineVision) Redmond Polymer Cervical Cage (A-Spine) STALIF C-Ti™ (Centinel Spine) AIS-C 3DP Stand-Alone Cervical Cage (Genesys Spine) AIS-C Stand-Alone System (Genesys Spine) PRORAY™ (PRODORTH) PROYSTER® (PRODORTH) Capri-Z (Tsunami Medical) T-lock Cervical Stand-alone Cage (BAUI) ACIFBOX Stand Alone Cervical Cage Alta System Align SA-C ACIFBOX Cervical Cage with Blade Aero-C ARION Expandable Bladed Cervical Cage Arcadius ®XP C Spinal System AVS® Anchor-C Cervical Cage Autoblock Anterior Cervical Cage A-CIFT™ SoloFuse™ Blackhawk™Cervical Spacer ChoiceSpine Blackhawk™ Ti Cervical Spacer ChoiceSpine CoRoent® Small Interlock™ COALITION ClariVy Cervical IBF System C-Fix Peek Cedix-P Spacer COALITION MIS® SintrOS™ Crea STAND-ALONE CERVICAL PEEK CAGE COALITION MIS™ CHESAPEAKE® Cervical-Ti Stabilization System CAVUX Cervical Cage-L SA System C2C Cervical Titanium Spine System Ceres-C Stand-alone Cavetto- SA™ Ti C-CURVE™ Dakota ACDF™ System Dolomite ACSS System Divergence Emminent Spine Cervical Cage Endoskeleton® TCS HiJAK AC Hive™ Standalone Cervical System HRCC® HEDRON IC™ Intervertebral cervical locking cage F3D C2 Stand Alone Cervical Irix-C™ InterPlate™ IFD IN:C2 Cervical Cage Kentro SELF Standalone Cervical cage LorX ACIF Peek Cage L-ACIF LONESTAR® Cervical Stand Alone Monza Miraclus ACC Mecta-C Stand Alone Interbody Fusion Monet™ Anterior Cervical Fusion system MINERVA NEXXT MATRIXX® Stand Alone Cervical System Optio-C® Anterior Cervical System OVERFIX Cervical Cage ONIX Paramount® Anterior Cervical Cage Pegasus Anchored Cervical Interbody Pallas Low Profile Anterior Cervical Cage PRO-LINK Ti Titanium Stand-Alone Cervical Spacer System Pro-less Cage PRO-LINK Stand-Alone cervical spacer PL-AGE® Anterior Cervical Fusion System PEEK Prevail® ReConnect Cage ROI-C Rig®-ZP (Zero Profile Cervical cage) Romero Self-Anchored Cervical Cage Red Ruby ACI SPIRA- C Integrated Interbody system STACC SABER C™ Cervical Fusion System SCARLET®AC-T SKATE, Cervical Plate Kit SPICCA-SP Solitaire™-C Cervical Shoreline RT® Siluette Shoreline® ACS Tesera SC Stand-alone TRUSS CSTS-SA TOMCAT™ Cervical Spinal System Titanopeek-C Stand Alone Vertu® Cervical Implant System Unicorn CS VariLift®-C Vault C Anterior Cervical Velofix™ SA Cervical Cage Veyron-C System Walnut X-Zone System ZERO-P™ VA Stand Alone Spacer ZERO-PZ-LINK™ Cervical Zero-Profile Anterior Cervical Intervertebral Locking Plate And Cage Combination System ---- [[Acrylic cage]] see [[Cespace xp]] Stabilis Stand Alone Cage Bagby and Kuslich (BAK) device. ---- Variations include the use of [[cervical cage]]s made of several materials instead of [[autologous bone]] and the use of cages with or without [[cervical plating]]. The stand-alone cervical cages (SAc) have the advantages of less surgical time, less bleeding, and less cervical tissue dissection, with a lesser ratio of postoperative dysphagia and quicker recovery ((Chen Y , Lü G , Wang B , Li L , Kuang L . A comparison of anterior cervical discectomy and fusion (ACDF) using self-locking stand-alone polyetheretherketone (PEEK) cage with ACDF using cage and plate in the treatment of three-level cervical degenerative spondylopathy: a retrospective study with 2-year follow-up. Eur Spine J. 2016;25(7):2255–2262. doi:10.1007/s00586-016-4391-x )). ---- HA, coralline HA, sandwiched HA, TCP, and [[biphasic calcium phosphate ceramics]] were used in combination with osteoinductive materials such as bone marrow aspirate and various cages composed of poly-ether-ether-ketone (PEEK), fiber carbon, and titanium. Stand-alone ceramic spacers have been associated with fracture and cracks. Metallic cages such as titanium endure the risk of subsidence and migration. PEEK cages in combination with ceramics were shown to be a suitable substitute for autograft. None of the discussed options has demonstrated clear superiority over others, although direct comparisons are often difficult due to discrepancies in data collection and study methodologies. Future randomized clinical trials are warranted before definitive conclusions can be drawn ((Zadegan SA, Abedi A, Jazayeri SB, Bonaki HN, Vaccaro AR, Rahimi-Movaghar V. Clinical Application of Ceramics in Anterior Cervical Discectomy and Fusion: A Review and Update. Global Spine J. 2017 Jun;7(4):343-349. doi: 10.1177/2192568217699201. Epub 2017 Apr 20. Review. PubMed PMID: 28815162; PubMed Central PMCID: PMC5546682. )). There has been an increase in the use of standalone cage devices due to ease of use and studies suggesting a lower rate of acute post-operative dysphagia. Stand-alone cervical [[cage]]s aim to provide primary stability, yield solid fusion in the long-term course, and maintain physiologic alignment. However, many implants designed for these purposes fail in achieving these goals. There is evidence documenting relatively frequent complications in stand-alone [[cage]] assisted [[anterior cervical discectomy and fusion]] (ACDF), such as [[cage subsidence]] and [[cervical kyphosis]] ((Cloward RB: The anterior approach for removal of ruptured cervical disks. 1958. J Neurosurg Spine 6:496-511, 2007)). Failure of disc height maintenance may lead to cervical kyphosis and poor alignment of the cervical spine. At the same time, costs for cage implantation are relatively high compared with their unfavorable radiologic performance. Brenke et al, develop and test mechanically a low-cost polymethylmethacrylate (PMMA) cage with similar mechanical and procedural properties compared with a commercial polyetheretherketone (PEEK) cage. Following determination of the cage design, a casting mold was developed for the production of PMMA cages. Nine cages were produced and compared with nine PEEK cages using static compression tests for 0 and 45 degrees according to the recommendations of the American Society for Testing and Materials. Mean compressive yield strength, mean yield displacement, mean tensile strength, and mean stiffness were determined. Results At 0 degrees axial compression, the mean compressive yield strength, mean displacement, and mean tensile strength of the PMMA cage was significantly higher compared with the PEEK cage (p < 0.001). Stiffness of both implants did not differ significantly (p = 0.903). At 45 degrees axial compression, PEEK cages could not be investigated because slipping of the holding fixture occurred. Under these conditions, PMMA cages showed a mean compressive yield strength of 804.9 ± 60.5 N, a mean displacement of 0.66 mm ± 0.05 mm, a mean tensile strength of 7.92 ± 0.6 N/mm2, and a mean stiffness of 1,228 ± 79.4 N/mm. The developed PMMA cage seems to show similar to superior mechanical properties compared with the commercial PEEK cage. Considering a preparation time of only 10 minutes and the low price for the PMMA material, the cost-benefit ratio clearly points to the use of the PMMA cage. However, clinical effectiveness has to be proven in a separate study ((Brenke C, Pott P, Schwarz ML, Schmieder K, Barth M. Development of a Low-Cost Polymethylmethacrylate Stand-Alone Cervical Cage: Technical Note. J Neurol Surg A Cent Eur Neurosurg. 2014 Feb 19. [Epub ahead of print] PubMed PMID: 24554608.)). ===== Cervical corpectomy cage ===== [[Cervical corpectomy cage]]