Implanting standalone expandable cages following anterior cervical corpectomy and fusion is a safe and effective procedure

Mohamed Tohamy

The use of a standalone expandable cage in the cervical spine after one or two-level anterior cervical corpectomy and fusion (ACCF) without additional posterior fixation or anterior plating is a safe procedure that results in fusion, new research has shown.

The findings of this study—which were published by Mohamed Tohamy (Martin-Ulbrich-Haus Rothenburg, Germany) in the BMC Musculoskeletal Disorders journal in cooperation with Georg Osterhoff and Christoph Heyde (University of Leipzig, Germany) as well as colleagues at the Helios Klinikum Erfurt (Erfurt, Germany)—also observed that there was no significant subsidence of the cages nor significant loss of lordotic correction.

The study, which the researchers say is the first of its kind with this number of patients, aimed to evaluate radiographic and clinical outcomes in patients with multilevel degenerative cervical spine disease treated by standalone cages for ACCF.

A total of 31 patients (66.5 ± 9.75 years, range 53–85 years) were analysed. Visual Analog Scale (VAS) and the 10-item Neck Disability Index (NDI) were assessed preoperatively and during follow-up on a regular basis after surgery and after a minimum of one year.

Assessment of radiographic fusion, subsidence, and lordosis measurement of global cervical lordosis (GCL); fusion site lordosis (FSL); the anterior interbody space height; the posterior interbody space height; the distance of the cage to the posterior wall of the vertebral body (CD), were done retrospectively. Mean clinical and radiographic follow-up was 20 ± 4.39 months.

The preoperative VAS-neck increased postoperatively (p=0.013) and then improved at final follow-up (p=0.001). The preoperative VAS-arm decreased (p=0.001) at the end of follow up. The VAS-arm was not statistically different to the postoperative (p=0.336).

The value for the NDI improved from an initial presentation (p=0.001) and at final follow-up (p=0.001). There were also no revision surgeries necessary.

In terms of dysphagia-related symptoms, 20 patients out of 31 patients (64.5%) had mild symptoms like difficulty in swallowing. In all cases, these symptoms disappeared within two days after surgery and no patient had dysphagia at the time of discharge.

Compared to the preoperative measurement (11.8° ± 8.19°), GCL was significantly increased postoperatively (15.8° ± 7.34°, p=0.025) and at final follow up (14.9° ± 7.12°, p=0.021) while these postoperative measurements showed an insignificant difference (p=0.319). In contrast, postoperative (7.5° ± 3.9°) and follow-up FSL measurements (7.9° ± 5.41°) showed no significant differences compared to the preoperative values (7.1° ± 4.35°, p=0.261/0.379).

The comparison between anterior interbody space height, posterior interbody space height and the CD postoperatively and at last follow-up showed no change in anterior and posterior DSH, but a significant decrease in CD showed between postoperative and follow-up measurement p=0.05.

Speaking to Spinal News International, Tohamy said: “Application of a stand-alone expandable titanium cage in the cervical spine after one or two level ACCF without additional posterior fixation or anterior plating is a safe procedure that normally results in fusion. However, it may need a surgical skill to limit the over-distraction of the cage to decrease the percentage of the subsidence or to prevent its loosening. In other words, if the cage is primarily stable with a fair and enough distraction forces and there is an intact posterior column, extra anterior plating is not a necessity.”


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