Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study.

Abstract

Reconstruction after anterior cervical decompression has involved the use of tricortical iliac crest bone or fibular strut grafts, but has been associated with significant morbidity. In this study the authors evaluated the efficacy of titanium mesh cages (TMCs) for stability and fusion following anterior cervical corpectomy. Thirty-seven patients were prospectively evaluated during a 4-year period. The majority presented with spinal cord compression (97%) often due to cervical spondylosis (87%). The TMC was filled with iliac crest bone chips or Surgibone and stabilized by anterior cervical plates (ACPs). The changes in settling ratio, coronal and sagittal angles, and sagittal displacement were determined at 3, 6, and 12 months; immediate postoperative radiographs were used as baseline. Flexion-extension radiographs and computerized tomography (CT) scans (obtained at 1 year) were examined to assess stability, fusion, and bone growth within the TMC. Complications such as settling, telescoping, migration, and pseudarthrosis were not observed. Dynamic radiography revealed spinal stability in all patients. Cage-related complications occurred in 2.7% (TMC malplacement [one patient]), surgery-related complications in 10.8%, and graft-related complications in 21.6%. Evidence of bone growth into the TMC was documented in 16 (95%) of 17 patients on CT scans. The mean cage height-related settling rates were 4.46% at 3 months (31 patients [p = 0.066]), 3.89% at 6 months (28 patients [p = 0.028]), and 4.35% at 1 year (27 patients [p = 0.958]). The mean sagittal displacement changed by 3.9% (23 patients [p = 0.73]). The mean coronal and sagittal angles changed 2.89 degrees (30 patients [p = 0.498]) and 2.09 degrees (29 patients [p = 0.001]) at 1 year, respectively, or at last follow up from baseline. No significant differences in the radiological indices were seen when multilevel vertebrectomy cases were compared with single-level vertebrectomy (p = 0.221), smoking status, or age. Conclusions. Titanium mesh cages, in combination with ACPs, are safe and effective for vertebral replacement in the cervical spine.