Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-10-2011 | Orthopaedic Surgery

Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients

Authors: Denglu Yan, Zhaojie Wang, Shaojie Deng, Jian Li, Chenglong Soo

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2011

Abstract

Objective

This retrospective study was to evaluate the relationship between osteoporosis and dynamic cervical plates in screw–plate or screw–bone interface of elderly cervical spondylotic myelopathy (CSM) patients.

Methods

Retrospective study was conducted on elderly CSM patients, treated by anterior corpectomy and reconstruction with titanium mesh cages (TMC) and dynamic cervical plate between July 2004 and June 2007. All patients underwent bone mineral density (BMD) assessment in preoperation, and according to the osteoporosis degree they have been divided into two groups: moderate osteoporosis degree group and severe osteoporosis degree group. The clinical outcome [Japanese Orthopaedic Association score (JOA) and Visual Analogue Scale (VAS)], bone fusion assessment (CT mielogram), the change of titanium mesh cages and plate of cephalic screw-plate-angle (SPA) and cephalic endplate-plate-angle (EPA) of plain X-ray films were measured.

Results

The mean JOA score and recovery rate were not different between the two groups (P > 0.05). There was no loss of sagittal alignment after surgery in any patient, and no significant difference between both groups on lordosis measurements (P > 0.05). Although there was a significant difference of the cage subsidence rate between the two groups (P < 0.001), all patients had favorable bone union and none required additional treatment. The average changes of SPA were greater in A group patients than in B group patients, while the variation of EPA was higher in B group patients than in A group patients (P < 0.001).

Conclusions

Despite the fact that there is a significant difference of the cage subsidence rate between the two groups no clinical outcome, nor sagittal alignment or fusion rate differences among groups was observed in elderly CSM patients.

Acosta FL, Aryan HE, Chou D, Ames CP (2008) Long-term biomechanical stability and clinical improvement after extended multilevel corpectomy and circumferential reconstruction of the cervical spine using titanium mesh cages. J Spinal Disord Tech 21(3):165–174PubMedCrossRef

Barnes MP, Saunders M (1984) The effect of cervical mobility on the natural history of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry 47(1):17–20PubMedCrossRef

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976) 20(12):1410–1418

Eck KR, Bridwell KH, Ungacta FF, Lapp MA, Lenke LG, Riew KD (2000) Analysis of titanium mesh cages in adults with minimum two-year follow-up. Spine (Phila Pa 1976) 25(18):2407–2415CrossRef

Fassett DR, Apfelbaum R, Clark R, Bachus KN, Brodke DS (2005) Biomechanical analysis of a new concept: an add-on dynamic extension plate for adjacent-level anterior cervical fusion. Spine (Phila Pa 1976) 30(22):2523–2529CrossRef

Fernyhough JC, White JI, LaRocca H (1991) Fusion rates in multilevel cervical spondylosis comparing allograft fibula with autograft fibula in 126 patients. Spine (Phila Pa 1976) 16(10 Suppl):S561–S564CrossRef

Fessler RG, Steck JC, Giovanini MA (1998) Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery 43(2):257–265 (Discussion 265–257)PubMedCrossRef

Herkowitz HN (1989) The surgical management of cervical spondylotic radiculopathy and myelopathy. Clin Orthop Relat Res 239:94–108PubMed

Hussain M, Natarajan RN, Fayyazi AH, Braaksma BR, Andersson GB, An HS (2009) Screw angulation affects bone-screw stresses and bone graft load sharing in anterior cervical corpectomy fusion with a rigid screw-plate construct: a finite element model study. Spine J 9(12):1016–1023PubMedCrossRef

10.

Hwang S-L, Lee K-S, Su Y-F et al (2007) Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. J Spinal Disord Tech 20(8):565–570PubMedCrossRef

11.

Ikenaga M, Shikata J, Tanaka C (2005) Anterior corpectomy and fusion with fibular strut grafts for multilevel cervical myelopathy. J Neurosurg Spine 3(2):79–85PubMedCrossRef

12.

Ikenaga M, Shikata J, Tanaka C (2006) Long-term results over 10 years of anterior corpectomy and fusion for multilevel cervical myelopathy. Spine (Phila Pa 1976) 31(14):1568–1574 discussion 1575CrossRef

13.

Kanayama M, Cunningham BW, Weis JC, Parker LM, Kaneda K, McAfee PC (1998) The effects of rigid spinal instrumentation and solid bony fusion on spinal kinematics:a posterolateral spinal arthrodesis model. Spine (Phila Pa 1976) 23(7):767–773CrossRef

14.

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9(8):1137–1141PubMedCrossRef

15.

Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H (2000) A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res 381:129–136PubMedCrossRef

16.

Kirkpatrick JS, Levy JA, Carillo J, Moeini SR (1999) Reconstruction after multilevel corpectomy in the cervical spine A sagittal plane biomechanical study. Spine (Phila Pa 1976) 24(12):1186–1190 discussion 1191CrossRef

17.

Kristof RA, Kiefer T, Thudium M et al (2009) Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy. Eur Spine J 18(12):1951–1956PubMedCrossRef

18.

LaRocca H (1988) Cervical spondylotic myelopathy: natural history. Spine (Phila Pa 1976) 13(7):854–855CrossRef

19.

Macdonald RL, Fehlings MG, Tator CH et al (1997) Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86(6):990–997PubMedCrossRef

20.

Majd ME, Vadhva M, Holt RT (1999) Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976) 24(15):1604–1610CrossRef

21.

Matz PG, Anderson PA, Holly LT et al (2009) The natural history of cervical spondylotic myelopathy. J Neurosurg Spine 11(2):104–111PubMedCrossRef

22.

Min J-H, Jung B-J, Jang J-S, Kim S-K, Jung D-J, Lee S-H (2009) Spinal cord herniation after multilevel anterior cervical corpectomy and fusion for ossification of the posterior longitudinal ligament of the cervical spine. J Neurosurg Spine 10(3):240–243PubMedCrossRef

23.

Montgomery DM, Brower RS (1992) Cervical spondylotic myelopathy Clinical syndrome and natural history. Orthop Clin North Am 23(3):487–493PubMed

24.

Oh MC, Zhang HY, Park JY, Kim KS (2009) Two-level anterior cervical discectomy versus one-level corpectomy in cervical spondylotic myelopathy. Spine (Phila Pa 1976) 34(7):692–696CrossRef

25.

Orr RD, Zdeblick TA (1999) Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop Relat Res 359:58–66PubMedCrossRef

26.

Rafael H (2003) Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 53(3):787 author reply 787–788PubMedCrossRef

27.

Reidy D, Finkelstein J, Nagpurkar A, Mousavi P, Whyne C (2004) Cervical spine loading characteristics in a cadaveric C5 corpectomy model using a static and dynamic plate. J Spinal Disord Tech 17(2):117–122PubMedCrossRef

28.

Saunders RL, Bernini PM, Shirreffs TG, Reeves AG (1991) Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74(2):163–170PubMedCrossRef

29.

Vaccaro AR, Falatyn SP, Scuderi GJ et al (1998) Early failure of long segment anterior cervical plate fixation. J Spinal Disord 11(5):410–415PubMedCrossRef

30.

Yamazaki T, Yanaka K, Sato H, Uemura K, Tsukada A, Nose T (2003) Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52(1):122–126 discussion 126PubMed

31.

Zdeblick TA, Bohlman HH (1989) Cervical kyphosis and myelopathy Treatment by anterior corpectomy and strut-grafting. J Bone Joint Surg Am 71(2):170–182PubMed

32.

Zdeblick TA, Ducker TB (1991) The use of freeze-dried allograft bone for anterior cervical fusions. Spine (Phila Pa 1976) 16(7):726–729CrossRef

Title: Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients
Authors: Denglu Yan
Zhaojie Wang
Shaojie Deng
Jian Li
Chenglong Soo
Publication date: 01-10-2011
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2011
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-011-1317-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate for cervical spondylotic myelopathy in elderly osteoporosis patients

Abstract

Objective

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2011

How reliable are CT scans for the evaluation of calcaneal fractures?

A quantitative analysis of tension band plating of the femur diaphysis

A concern regarding the diagnosis of injury of a bipartite patella at the lower part of the patella

Secondary bone lesions in the affected limb in osteosarcoma (skip lesions), its classification and prognosis

Does medial rotational deformity of the whole pelvis universally exist in unilateral DDH?

Revitalization of cortical bone allograft by application of vascularized scaffolds seeded with osteogenic induced adipose tissue derived stem cells in a rabbit model