Cervical corpectomy cage

Expandable interbody cages are frequently used to reconstruct the anterior spinal column after a corpectomy.

In case of spinal cord compression behind the vertebral body,anterior cervical corpectomy and fusion (ACCF) proves to be a more feasible approach than cervical discectomy. The next step was the placement of an expandable titanium interbody in order to restore the vertebral height. The need for additional anterior plating with ACCF has been debatable and such technique has been evaluated by very few studies.

In a retrospective study, Pojskic et al. evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage.

Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable cervical titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Score) and gait disturbances with the Nurick scale. Radiographic analysis comprised measurement of fusion, subsidence and the C2-C7 angle.

Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastases (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). In 39 patients (45.3%), additional dorsal stabilization (360° fusion) was performed. In 13 patients, hardware failure occurred, and in 8 patients, adjacent segment disease occurred. Improvement of pain symptoms, myelopathy, and gait following surgery were statistically significant (p < 0.05), with a medium preoperative VAS of 8, a postoperative score of 3.2, and medium EMS scores of 11.3 preoperatively vs. 14.3 postoperatively. Radiographic analysis showed successful fusion in 74 patients (86%). As shown in previous studies, correction of the C2-C7 angle did not correlate with improvement of neurological symptoms.

The results show that expandable titanium cages are a safe and useful tool in anterior cervical corpectomy for providing adequate anterior column support and stability ¹⁾.