Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations

Vanni, Daniele; Pantalone, Andrea; Magliani, Vincenzo; Salini, Vincenzo; Berjano, Pedro

doi:10.21037/jss.2017.08.06

Cited by 15 publications

(21 citation statements)

References 22 publications

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“…Several clinical studies have shown the efficacy of the expandable cage, mostly in the cervical spine [2][3][4][5][6][7]10,[15][16][17][18][19][20][21]. Most common indications were, similar to our study, cervical spinal canal stenosis [7,12], metastases [5,10,17], fractures [2,6] and spondylodiscitis [4,19].…”

Section: Discussionsupporting

confidence: 80%

“…Expandable cages (ECs) are frequently used to reconstruct the anterior spinal column after corpectomy. Indications include spinal canal stenosis with compression of the spinal cord [1], fracture [2,3], spondylodiscitis [4], and metastases [5]. Corpectomy of the cervical spine is performed through the anterior approach with the need of a graft or implant device for reconstruction [6].…”

Section: Introductionmentioning

confidence: 99%

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Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

et al. 2020

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Background and objectives: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Materials and Methods: Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Scale) and gait disturbances with the Nurick score. Radiographic analysis comprised measurement of fusion, subsidence and the C2–C7 angle. Results: Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastasis (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). In 39 patients (45.3%), additional dorsal stabilization (360° fusion) was performed. In 13 patients, hardware failure occurred, and in 8 patients, adjacent segment disease occurred. Improvement of pain symptoms, myelopathy, and gait following surgery were statistically significant (p < 0.05), with a medium preoperative VAS of 8, a postoperative score of 3.2, and medium EMS scores of 11.3 preoperatively vs. 14.3 postoperatively. Radiographic analysis showed successful fusion in 74 patients (86%). As shown in previous studies, correction of the C2–C7 angle did not correlate with improvement of neurological symptoms. Conclusion: Our results show that expandable titanium cages are a safe and useful tool in anterior cervical corpectomies for providing adequate anterior column support and stability.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

et al. 2020

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“…It was recommended to perform multilevel pedicle screw fixation but this was problematic in already osteoporotic elderly patients, where pedicle screws in adjacent osteoporotic vertebrae would loosen or not hold, as well as the elderly patients having significant medical co-morbidities that precluded a major spinal surgical procedure. Often fixation was done without correction of the collapsed vertebrae or correction of the kyphosis, which led to further fracture progression [ 2 , 3 ]. Recently, short segment pedicle fixation combined with kyphoplasty or vertebral corpectomy and vertebral replacement was suggested to improve the kyphosis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Re-expansion and Stabilization of Vertebra Plana Fractures Using Bilateral SpineJack® Implants

Joyce¹,

Granville²,

Jacobson³

2021

Cureus

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The surgical treatment of osteoporotic vertebral fractures with greater than 70% collapse, known as "Vertebra Plana (VP)" has been controversial. Originally VP was a considered a contraindication to vertebroplasty or kyphoplasty because of presumed difficulty of entering the collapsed vertebra as well as obtaining significant re-expansion or correct associated sagittal kyphosis. In some cases, multilevel pedicle screw fixation with or without attempts to correct the collapse is still performed to correct the kyphosis or prevent progression. With experience it was clear that the pedicle could be accessed and VP could be treated without added risk of epidural leak of cement or epidural extravasation. Now, with the introduction of newer third-generation intraspinal expansion devices that are larger and need to be placed bilaterally, their use in cases of VP was again an issue since VP cases were excluded from the original multicenter studies used for worldwide approval. This report reviews six cases of VP treated with bilateral SpineJack® implants (Stryker Corp, Kalamazoo, Michigan, USA) demonstrating it is not only feasible to place these larger size implants but achieve significant reconstitution of vertebral height as well as correction of the kyphotic deformity.

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“…This may be because of the poor general condition and frequent instrumentation failure resulting from low bone quality in elderly patients. To treat these patients, a less invasive surgical approach in combination with more rigid fixation may be optimal [ 8 ], but some patients still require revision surgery because of progression of their kyphotic deformity, instrumentation failure, or both. Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

Ohba

Yokomichi

Koyama

et al. 2020

BMC Musculoskelet Disord

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Abtsract Background Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine postoperative mortality. Methods We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of ≤3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL. Results The mean follow-up time was 4.1 ± 0.8 years. Two years after surgery, percentage of patients who had died was 15%. The VAS scores and modified Frankel classification were significantly improved one year after surgery. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. The univariate analysis showed that male gender, serum albumin < 3.5 g/dl, creatinine clearance< 60 mg/dl, and the American Society of Anesthesiologists classificat0ion ≥3 were significant risk factors for postoperative mortality. Multivariate analysis revealed that only serum albumin ≤3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF. Conclusions Preoperative hypoalbuminemia was associated with postoperative mortality following surgery for OVF. Level of evidence Level 3.

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Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations

Cited by 15 publications

References 22 publications

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

Re-expansion and Stabilization of Vertebra Plana Fractures Using Bilateral SpineJack® Implants

Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

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