Evaluation of Anterior Cervical Reconstruction with Titanium Mesh Cages versus Nano-Hydroxyapatite/Polyamide66 Cages after 1- or 2-Level Corpectomy for Multilevel Cervical Spondylotic Myelopathy: A Retrospective Study of 117 Patients
Objective To retrospectively compare the efficacy of the titanium mesh cage (TMC) and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage) for 1- or 2-level anterior cervical corpectomy and fusion (ACCF) to treat multilevel cervical spondylotic myelopathy (MCSM). Methods A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28±12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy) and cage type used (TMC or n-HA/PA66 cage). Clinical and radiological parameters were used to evaluate outcomes. Results At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01), and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01). Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values. Conclusion The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.
References
[1]
Lin Q, Zhou X, Wang X, Cao P, Tsai N, et al. (2012) A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J 21: 474–481. doi: 10.1007/s00586-011-1961-9
[2]
Song KJ, Lee KB, Song JH (2012) Efficacy of multilevel anterior cervical discectomy and fusion versus corpectomy and fusion for multilevel cervical spondylotic myelopathy: a minimum 5-year follow-up study. Eur Spine J 21: 1551–1557. doi: 10.1007/s00586-012-2296-x
[3]
Edwards CC 2nd, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine (Phila Pa 1976) 27: 1168–1175. doi: 10.1097/00007632-200206010-00007
[4]
Tani T, Ushida T, Ishida K, Iai H, Noguchi T, et al. (2002) Relative safety of anterior microsurgical decompression versus laminoplasty for cervical myelopathy with a massive ossified posterior longitudinal ligament. Spine (Phila Pa 1976) 27: 2491–2498. doi: 10.1097/00007632-200211150-00013
[5]
Lian XF, Xu JG, Zeng BF, Zhou W, Kong WQ, et al. (2010) Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study. Eur Spine J 19: 713–719. doi: 10.1007/s00586-010-1319-8
[6]
Herkowitz HN (1988) A comparison of anterior cervical fusion, cervical laminectomy, and cervical laminoplasty for the surgical management of multiple level spondylotic radiculopathy. Spine (Phila Pa 1976) 13: 774–780. doi: 10.1097/00007632-198807000-00011
[7]
Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, et al. (2009) Cervical laminoplasty for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11: 157–169. doi: 10.3171/2009.1.spine08726
[8]
Lu J, Wu X, Li Y, Kong X (2008) Surgical results of anterior corpectomy in the aged patients.with cervical myelopathy. Eur Spine J 17: 129–135. doi: 10.1007/s00586-007-0518-4
[9]
Dorai Z, Morgan H, Coimbra C (2003) Titanium cage reconstruction after cervical corpectomy. J Neurosurg Spine 99: 3–7. doi: 10.3171/spi.2003.99.1.0003
[10]
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: 692–696. doi: 10.1097/brs.0b013e318199690a
[11]
Hilibrand AS, Fye MA, Emery SE, Palumbo MA, Bohlman HH (2002) Increased rate of arthrodesis with strut grafting after multilevel anterior cervical decompression. Spine (Phila Pa 1976) 27: 146–151. doi: 10.1097/00007632-200201150-00005
[12]
Wittenberg RH, Moeller J, Shea M, White AA 3rd, Hayes WC (1990) Compressive strength of autologous and allogenous bone grafts for thoracolumbar and cervical spine fusion. Spine (Phila Pa 1976) 15: 1073–1078. doi: 10.1097/00007632-199015100-00017
[13]
Kotil K, Tari R (2011) Two level cervical corpectomy with iliac crest fusion and rigid plate fixation: a retrospective study with a three-year follow-up. Turk Neurosurg 21: 606–612. doi: 10.5137/1019-5149.jtn.4739-11.2
[14]
Kinoshita A, Kataoka K, Taneda M (1999) Multilevel vertebral body replacement with a titanium mesh spacer for aneurysmal bone cyst: technical note. Minim Invasive Neurosurg 42: 156–158. doi: 10.1055/s-2008-1053390
[15]
Yan D, Wang Z, Deng S, Li J, Soo C (2011) Anterior corpectomy and reconstruction with titanium mesh cage and dynamic cervical plate forcervical spondylotic myelopathy in elderly osteoporosis patients. Arch Orthop Trauma Surg 131: 1369–1374. doi: 10.1007/s00402-011-1317-2
[16]
Hee HT, Madj ME, Holt RT, Whitecloud TS 3rd, Pienkowski D (2003) Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. J Spinal Disord 16: 1–8. doi: 10.1097/00024720-200302000-00001
[17]
Lim TH, Kwon H, Jeon CH, Kim JG, Sokolowski M, Natarajan R, et al. (2001) Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion. Spine (Phila Pa 1976) 26: 951–956. doi: 10.1097/00007632-200104150-00021
[18]
Lee SH, Sung JK (2008) Anterior cervical stabilization using a semi-constrained cervical plate and titanium. J Clin Neurosci 15: 1227–1234. doi: 10.1016/j.jocn.2007.09.019
[19]
Ying Z, Xinwei W, Jing Z, Shengming X, Bitao L, et al. (2007) Cervical corpectomy with preserved posterior vertebral wall for cervical spondylotic myelopathy: a randomized control clinical study. Spine (Phila Pa 1976) 32: 1482–1487. doi: 10.1097/brs.0b013e318068b30a
[20]
Zhao Z, Jiang D, Ou Y, Tang K, Luo X, et al. (2012) A hollow cylindrical nanohydroxyapatite/polyamide composite strut for cervical reconstruction after cervical corpectomy. J Clin Neurosci 19: 536–540. doi: 10.1016/j.jocn.2011.05.043
[21]
Yang X, Chen Q, Liu L, Song Y, Kong Q, et al. (2013) Comparison of anterior cervical fusion by titanium mesh cage versus nano-hydroxyapatite/polyamide cage following single-level corpectomy. Int Orthop 37: 2421–2427. doi: 10.1007/s00264-013-2101-4
[22]
Wang X, Li Y, Wei J, de Groot K (2002) Development of biomimetic nano-hydroxyapatite/poly(hexamethylene adipamide) composites. Biomaterials 23: 4787–4791. doi: 10.1016/s0142-9612(02)00229-6
[23]
Gercek E, Arlet V, Delisle J, Marchesi D (2003) Subsidence of stand-alone cervical cages in anterior interbody fusion: warning. Eur Spine J 12: 513–516. doi: 10.1007/s00586-003-0539-6
[24]
Andaluz N, Zuccarello M, Kuntz C (2012) Long-term follow-up of cervical radiographic sagittal spinal alignment after 1- and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study. J Neurosurg Spine 16: 2–7. doi: 10.3171/2011.9.spine10430
[25]
Liu Y, Qi M, Chen H, Yang L, Wang X, et al. (2012) Comparative analysis of complications of different reconstructive techniques following anterior decompression for multilevel cervical spondylotic myelopathy. Eur Spine J 21: 2428–2435. doi: 10.1007/s00586-012-2323-y
[26]
Kirkpatric 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: 1186–1191. doi: 10.1097/00007632-199906150-00003
[27]
Sevki K, Mehmet T, Ufuk T, Azmi H, Mercan S, et al. (2004) Results of surgical treatment for degenerative cervical myelopathy: anterior cervical corpectomy and stabilization. Spine (Phila Pa 1976) 29: 2493–2500. doi: 10.1097/01.brs.0000145412.93407.c3
[28]
Chibbaro S, Benvenuti L, Carnesecchi S, Marsella M, Pulera F, et al. (2006) Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci 13: 233–238. doi: 10.1016/j.jocn.2005.04.011
[29]
Bilbao G, Duart M, Aurrecoechea JJ, Pomposo I, Igartua A, et al. (2010) Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies. Acta Neurochir (Wien) 152: 1155–1163. doi: 10.1007/s00701-010-0660-3
[30]
Yang X, Song Y, Liu L, Liu H, Zeng J, et al. (2012) Anterior reconstruction with nano-hydroxyapatite/polyamide-66 cage after thoracic and lumbar corpectomy. Orthopedics 35: e66–73. doi: 10.3928/01477447-20111122-10
[31]
Daubs MD (2005) Early failures following cervical corpectomy reconstruction with titanium mesh cages and anterior plating. Spine (Phila Pa 1976) 30: 1402–1406. doi: 10.1097/01.brs.0000166526.78058.3c
[32]
Majd ME, Vadhva M, Holt RT (1999) Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976) 24: 1604–1610. doi: 10.1097/00007632-199908010-00016
[33]
Rieger A, Holz C, Marx T, Sanchin L, Menzel M (2003) Vertebral autograft used as bone transplant for anterior cervical corpectomy: technical note. Neurosurgery 52: 449–453. doi: 10.1227/01.neu.0000043815.31251.5b
[34]
HuangM, Feng J, Wang J, Zhang X, Li Y, et al. (2003) Synthesis and characterization of nano-HA/PA66 composites. J Mater Sci Mater Med 14: 655–660.
[35]
Xu Q, Lu H, Zhang J, Li G, Deng Z, et al. (2010) Tissue engineering scaffold material of porous nanohydroxyapatite/polyamide66. Int J Nanomedicine 13: 331–5. doi: 10.2147/ijn.s9869
[36]
Fengbin Y, Jinhao M, Xinyuan L, Xinwei W, Yu C, et al. (2013) Evaluation of a new type of titanium mesh cage versus the traditional titanium mesh cage for single-level, anterior cervical corpectomy and fusion. Eur Spine J 22: 2891–2896. doi: 10.1007/s00586-013-2976-1
[37]
Chen Y, Chen D, Guo Y, Wang X, Lu X, et al. (2008) Subsidence of titanium mesh cage: a study based on 300 cases. J Spinal Disord Tech 21: 489–492. doi: 10.1097/bsd.0b013e318158de22
