J Korean Neurosurg Soc.  2019 Nov;62(6):671-680. 10.3340/jkns.2019.0060.

Surgical Reconstruction Using a Flanged Mesh Cage without Plating for Cervical Spondylotic Myelopathy and a Symptomatic Ossified Posterior Longitudinal Ligament

• Kang JH
• Im SB
• Yang SM
• Chung M
• Jeong JH
• Kim BT
• Hwang SC
• Shin DS
• Park JH

• KMID: 2463659
• DOI: http://doi.org/10.3340/jkns.2019.0060

Abstract

OBJECTIVE
We introduce innovative method of cervical column reconstruction and performed the reconstruction with a flanged titanium mesh cage (TMC) instead of a plate after anterior corpectomy for cervical spondylotic myelopathy (CSM) and an ossified posterior longitudinal ligament (OPLL).
METHODS
Fifty patients with CSM or OPLL who underwent anterior cervical reconstruction with a flanged TMC were investigated retrospectively. Odom's criteria were used to assess the clinical outcomes. The radiographic evaluation included TMC subsidence, fusion status, and interbody height. Thirty-eight patients underwent single-level and 12 patients underwent two-level corpectomy with a mean follow-up period of 16.8 months.
RESULTS
In all, 19 patients (38%) had excellent outcomes and 25 patients (50%) had good outcomes. Two patients (4%) in whom C5 palsy occurred were categorized as poor. The fusion rate at the last follow-up was 98%, and the severe subsidence rate was 34%. No differences in subsidence were observed among Odom's criteria or between the single-level and two-level corpectomy groups.
CONCLUSION
The satisfactory outcomes in this study indicate that the flanged TMC is an effective graft for cervical reconstruction.

Keyword

Cervical vertebrae; Ossification of posterior longitudinal ligament; Spondylosis; Titanium

MeSH Terms

Cervical Vertebrae
Female
Follow-Up Studies
Humans
Longitudinal Ligaments*
Methods
Ossification of Posterior Longitudinal Ligament
Paralysis
Retrospective Studies
Spinal Cord Diseases*
Spondylosis
Titanium
Transplants
Titanium

Figure

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  Fig. 1. Prepared mesh cage. The titanium mesh cage had small flanges with a hole at the upper end and two holes at the lower end (black arrows). The cage was filled with autologous bone.

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  Fig. 2. Anterior interbody height (AIBH) and posterior interbody (PIBH) height measuring methods. AIBH is the length between the anterior portions of the adjacent upper and lower endplates (solid line). PIBH is the length between the posterior portions (dashed line).

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  Fig. 3. A 64-year-old man who underwent C3–4 corpectomy and reconstruction with flanged titanium mesh cage. A : Preoperative cervical magnetic resonance image (MRI); ossified posterior longitudinal ligament at C3–7. B : Cervical MRI 6 months after operation. C : Cervical X-ray at 6 months after surgery.

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  Fig. 4. A 56-year-old women who underwent C6 corpectomy and reconstruction with flanged titanium mesh cage. A : Preoperative cervical magnetic resonance imaging. B : Anteroposterior view; outward bended end of titanium mesh cage supports the vertebral body. C : Lateral view; flanges are fixed with screws are maintain well without extrusion.

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  Fig. 5. The subtotal corpectomy and reconstruction with one screw; the flanged cage contact to the rough cancellous bone surface. Cage dislocation has not occurred with one screw. Successful fusion is achieved.

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  Fig. 6. A : Empty space after corpectomy is trapezoid shape because of cervical lordosis and body alignment. B : Flanged cage with modifications; horizontally bent tip and trapezoid shape. C : Lateral cervical image; reconstruction with modified flanged cage.

Reference

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