Anterior expandable cylindrical cage reconstruction after cervical spinal metastasis resection

Alfieri, Alex; Gazzeri, Roberto; Neroni, Massimiliano; Fiore, Claudio; Galarza, Marcelo; Esposito, Stefano

doi:10.1016/j.clineuro.2011.02.023

Cited by 17 publications

(20 citation statements)

References 33 publications

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“…The use of the ADD or ADDplus were reported in nine studies, the Synex in two studies, the Tecorp-C in three studies, the TPS in two studies, the cervilift in one study, the Osteotech in one study, and the cage used was not specified in four studies. All patients either had additional placement of an anterior plate, posterior supplemental fixation, both, or a VBR with incorporated anterior fixation such as the ADDplus or TPS was used, except for two patients treated in the study by Alfieri et al [1] with a VBR alone.…”

Section: Resultsmentioning

confidence: 99%

“…A MEDLINE search was conducted using the search terms Bexpandable cage,^Bexpandable vertebral body replacement,^Bexpandable VBR,^Bdistractable cage,^Bdistractable vertebral body replacement,^Bdistractable VBR,^Bdistractible cage,^Bdistract-ible vertebral body replacement,^OR Bdistractible VBR,f rom January 1,1990 to October 31, 2014, as expandable cages were not used before this time. The same search terms were then used in a Google Scholar search.…”

Section: Methodsmentioning

confidence: 99%

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

Elder

Kosztowski

et al. 2015

Neurosurg Rev

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Elder

Kosztowski

et al. 2015

Neurosurg Rev

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“…[1][2][3][4][5] A new advanced method is use of expandable titanium cages which allow easy replacement with in situ expansion and reproduction of the sagittal profile. [9][10][11][12][13] Stabilization can be achieved by additional anterior plating or posterior stabilization by a rod and screw system. Alternatively, a direct fixation of the cages with fixation wings is possible, a combination of two systems in one -cage and fixation system.…”

Section: Discussionmentioning

confidence: 99%

Failure of an expandable cage-plate cervical vertebral body replacement: case report of a device related complication

Trieb

Koch

2017

Eklem Hastalik Cerrahisi

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“…For instance, patients with primary or benign spinal column tumors often experience prolonged survival, 17 which warrants the need for arthrodesis, although complications such as kyphosis, device subsidence, device loosening, or device fracture may be encountered. 2,4,15,46 In contrast, because patients harboring metastatic spinal column tumors or malignant tumors not amenable to en bloc resection may have relatively limited life expectancy, depending on factors such as tumor histology, extraspinal metastases, and performance status, 64 achievement of fusion may not be required. 21,54 Lastly, there are some limitations in bone graft options in spinal oncology.…”

mentioning

confidence: 99%

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

Elder

Ishida

Goodwin

et al. 2017

FOC

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OBJECTIVE With the advent of new adjunctive therapy, the overall survival of patients harboring spinal column tumors has improved. However, there is limited knowledge regarding the optimal bone graft options following resection of spinal column tumors, due to their relative rarity and because fusion outcomes in this cohort are affected by various factors, such as radiation therapy (RT) and chemotherapy. Furthermore, bone graft options are often limited following tumor resection because the use of local bone grafts and bone morphogenetic proteins (BMPs) are usually avoided in light of microscopic infiltration of tumors into local bone and potential carcinogenicity of BMP. The objective of this study was to review and meta-analyze the relevant clinical literature to provide further clinical insight regarding bone graft options. METHODS A web-based MEDLINE search was conducted in accordance with preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines, which yielded 27 articles with 383 patients. Information on baseline characteristics, tumor histology, adjunctive treatments, reconstruction methods, bone graft options, fusion rates, and time to fusion were collected. Pooled fusion rates (PFRs) and I2 values were calculated in meta-analysis. Meta-regression analyses were also performed if each variable appeared to affect fusion outcomes. Furthermore, data on 272 individual patients were available, which were additionally reviewed and statistically analyzed. RESULTS Overall, fusion rates varied widely from 36.0% to 100.0% due to both inter- and intrastudy heterogeneity, with a PFR of 85.7% (I2 = 36.4). The studies in which cages were filled with morselized iliac crest autogenic bone graft (ICABG) and/or other bone graft options were used for anterior fusion showed a significantly higher PFR of 92.8, compared with the other studies (83.3%, p = 0.04). In per-patient analysis, anterior plus posterior fusion resulted in a higher fusion rate than anterior fusion only (98.8% vs 86.4%, p < 0.001). Although unmodifiable, RT (90.3% vs 98.6%, p = 0.03) and lumbosacral tumors (74.6% vs 97.9%, p < 0.001) were associated with lower fusion rates in univariate analysis. The mean time to fusion was 5.4 ± 1.4 months (range 3–9 months), whereas 16 of 272 patients died before the confirmation of solid fusion with a mean survival of 3.1 ± 2.1 months (range 0.5–6 months). The average time to fusion of patients who received RT and chemotherapy were significantly longer than those who did not receive these adjunctive treatments (RT: 6.1 months vs 4.3 months, p < 0.001; chemotherapy: 6.0 months vs 4.3 months, p = 0.02). CONCLUSIONS Due to inter- and intrastudy heterogeneity in patient, disease, fusion criteria, and treatment characteristics, the optimal surgical techniques and factors predictive of fusion remain unclear. Clearly, future prospective, randomized studies will be necessary to better understand the issues surrounding bone graft selection following resection of spinal column tumors.

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Anterior expandable cylindrical cage reconstruction after cervical spinal metastasis resection

Cited by 17 publications

References 33 publications

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

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

Failure of an expandable cage-plate cervical vertebral body replacement: case report of a device related complication

Bone graft options for spinal fusion following resection of spinal column tumors: systematic review and meta-analysis

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