A systematic review of the use of expandable cages in the cervical spine

Abstract

Expandable vertebral body replacement cages (VBRs) have been widely used for reconstruction of the thoracolumbar spine following corpectomy. However, their use in the cervical spine is less common, and currently, no expandable cages on the market are cleared or approved by the US Food and Drug Administration for use in the cervical spine. The objective of this study was to perform a systematic review on the use of expandable cages in the treatment of cervical spine pathology with a focus on fusion rates, deformity correction, complications, and indications. A comprehensive Medline search was performed, and 24 applicable articles were identified and included in this review. The advantages of expandable cages include greater ease of implantation with less risk of damage to the end plate, less intraoperative manipulation of the device, and potentially greater control over lordosis. They may be particularly advantageous in cases with poor bone quality, such as patients with osteoporosis or metastatic tumors that have been radiated. However, there is a potential risk of overdistraction, which is increased in the cervical spine, their minimum height limits their use in cases with collapsed vertebra, and the amount of hardware in the expansion mechanism may limit the surface area available for fusion. The use of expandable VBRs are a valuable tool in the armamentarium for reconstruction of the anterior column of the cervical spine with an acceptable safety profile. Although expandable cervical cages are clearly beneficial in certain clinical situations, widespread use following all corpectomies is not justified due to their significantly greater cost compared to structural bone grafts or non-expandable VBRs, which can be utilized to achieve similar clinical outcomes.

Management of severe traumatic flexion-distraction injuries in a multisystem trauma patient: A case report

“…Meta-analysis of fusion rates for one-level ACDF and one-level corpectomy were found to be comparable at 97.1% and 92.9%, respectively [5] . Other studies report 79% to 100% fusion rates for a single and multilevel cervical corpectomy and fusion using an expandable cage [6] . Cabraja et al reports the fusion rate of 89% in expandable cage with anterior fixation screws group while it was 100% in expandable cage with a separate dynamic plate in a series of patients undergoing cervical corpectomy and fusion [7] .…”

The state of segmental kyphosis of operated segment after anterior subaxial cervical fusion using different types of stabilizing systems

“…Є багато публікацій, в яких доведено ефектив-ність застосування тих чи тих систем або їх комбінацій [9,10]. Повідомлено також про випадки неспромож-ного спондилодезу (міграції, деформації або фраг-ментації конструкції) [11,12].…”

Dynamics of pain intensity in patients after anterior subaxial cervical fusion

“…Розвиток вертебрології в останні десятиліття характеризується активним впровадженням у клінічну практику широкого спектру імплантатів стабілізувального або одночасно тілозамінного та стабілізувального призначення [3][4][5]. Велика кількість наукових робіт присвячена перевагам тих чи тих матеріалів, з яких виготовлено імплантати, конструктивними особливостями пристроїв, зручності установки конструкції під час оперативного втручання, динаміці рентгенологічної картини в післяопераційний період тощо [6][7][8][9][10].…”