Anatomy-related risk factors in Harm's mesh subsidence in cervical reconstruction after one-level corpectomy

Abstract

Objective To clarify anatomy-related factors in the cervical spine with subsidence of titanium mesh cage (TMC) after one-level cervical corpectomy and fusion. The effect of the cervical posture, segmental curvature and endplate gradient on this postoperative phenomenon was evaluated. Methods Between August 2003 and March 2006, a total of the 236 patients underwent one-level corpectomy and TMC fusion. Their radiological examinations were reviewed and clinical outcomes evaluated. Results In the patients who were followed up for 12 months, TMC subsidence occurred in 54 (28.6%) cases. C6 corpectomy had a significant higher risk (26/60, 43.3%) for TMC subsidence, which was correlated with the variation of the gradient of the vertebral endplates against cervical levels. Although the clinical outcome was comparable with those in the literature, the patients may have subsidence-related problems such as neck-shoulder pain, neurological deterioration and instrumental failure. Conclusion To decrease the incidence of subsidence, TMC design should be optimized to be in line with anatomic characteristics of the cervical spine.