Anterior Thoracolumbar Fusion with Titanium Mesh Cage

Abstract

Destructions of vertebral body due to various medical situations including acute fracture, tumor, post-traumatic deformity and infection lead to progressive destruction of vertebral body, kyphotic deformities and further neurological defecits. Titanium mesh cages (TMCs) with cancellous autograft bone after corpectomy of the thoracolumbar spine provide immediate structural support to the anterior column. The aim of this study was to evaluate the radiological, neurological and clinical outcomes of the patients with the TMCs-bone graft composite after thoracolumbar corpectomy. Sixteen patients underwent reconstruction using titanium mesh cages in thoracolumbar corpectomy between July 2000 and February 2005. The radiological and clinical course was documented over a mean follow-up duration of 28.2 months. The degree of kyphosis, construct height and the subsidence of the cage in relation to the vertebral endplates were measured preoperatively, early postoperatively, and at the latest follow-up. The mean kyphotic angle of 3.9 o before surgery was reduced to −2.6 o immediately after surgery, and at the last follow-up to be 3.4o . There was a significant difference between the preoperative versus postoperative kyphotic angle (p=0.003). The mean construct height of the involved vertebrae before surgery was 41.6 mm and the mean construct height immediate after surgery and at follow-up were 47.9 and 41.5 mm, respectively. There was a significant difference between the preoperative versus postoperative construct height (p＜0.0001). But there was no significant difference between the preoperative versus follow-up in kyphotic angle and construct height. The mean subsidence was 5.7 mm. However, there was no case of severe collapse or significant recurrence of deformity. In no patients, significant neurological deterioration was detected after surgery, and neither with major complications. This study demonstrated that TMCs after thoracolumbar corpectomy is a successful adjunct for anterior vertebral column reconstruction. In our cases, TMCs with anterior instrumentation allows a good structural support and maintain spinal alignment.