Titanium Mesh Cage Research Articles

Titanium mesh cage as an alternative reconstruction method for epiphyseal sparing tumor resections in children.

Titanium mesh cage as an alternative reconstruction method for epiphyseal sparing tumor resections in children.

Clinical Comparison of Surgical Constructs for Anterior Cervical Corpectomy and Fusion in Patients With Cervical Spondylotic Myelopathy or Ossified Posterior Longitudinal Ligament: A Systematic Review and Meta-Analysis.

This is a systematic review and meta-analysis. To examine the differences in outcomes among current constructs and techniques for anterior cervical corpectomy and fusion (ACCF) in patients with single or multiple level cervical myelopathy (CM) secondary to cervical spondylosis or ossified posterior longitudinal ligament. The natural history of CM can be a progressive disease process. In such cases, where surgical decompression is indicated to halt the progression, ACCF is typically chosen for pathology located posterior to the vertebral body. Numerous studies have shown that decompression with appropriate stabilization not only halts progression, but also improves patient outcomes. However, several constructs are available for this procedure, all with variable outcomes. A systematic review was conducted using Cochrane Database, Medline, and PubMed. Only studies with a minimum patient population of 10, reporting on CM because of cervical spondylosis or ossified posterior longitudinal ligament were included; a minimum follow-up period of 12 months and 1 clinical and/or radiographic outcome were required. Studies examining patients with cervical trauma/fracture, tumor, and infection or revision cases were excluded. Data analysis was carried out with Microsoft Excel. A total of 30 studies met the inclusion criteria for qualitative analysis, while 26 studies were included for quantitative analysis. Constructs that were reported in these studies included titanium mesh cages, nano-hydroxyapatite/polyamide 66 composite struts, bone graft alone, expandable corpectomy cages, and polyetheretherketone cages. Clinical outcomes included Japanese Orthopaedic Association and modified Japanese Orthopaedic Association scores, Visual Analog Scale scores, Neck Disability Index scores, and Nurick grades. Radiographic outcomes included C2-C7 and segmental Cobb angles and pseudarthrosis rates. Each construct type had variable and unique benefits and shortcomings. ACCF is a common surgical option for CM, despite carrying certain risks expected of any anterior cervical approach. Several constructs are available for ACCF, all with variable clinical and radiographic outcomes.

SURGICAL CORRECTION OF SUBAXIAL KYPHOSIS IN A CHILD WITH TYPE I NEUROFIBROMATOSIS: RARE CLINICAL CASE AND LITERATURE REVIEW

The paper presents a case of rapidly developing severe cervical kyphosis in a 5-year-old child which was the first clinical manifestation of type I neurofibromatosis (NF1). Surgical correction was carried out in two stages with preliminary hardware halo-traction and subsequent reconstruction of the spine using titanium mesh cage with bone autograft and posterior instrumentation. The deformity was corrected from the magnitude of 79° to the restoration of physiological lordosis. Long-term results were followed-up for 2.5 years with full maintenance of the achieved deformity correction. A 15-year literature review on the cervical spine lesions in NF1 is presented.

Man as a living bioreactor: Long-term histological aspects of a mandibular replacement engineered in the patient’s own body

In 2016, we reported the world’s first reconstruction of a mandibular discontinuity defect using a custom-made bone transplant that had been prefabricated in the gastrocolic omentum using tissue engineering strategies. However, the tissue of an engineered human neomandible has not been evaluated histologically until now. The current study assessed the long-term histological characteristics of biopsies of the neomandible 9months after transplantation. Histological analysis showed an increased amount of vital mineralized bone tissue after 10months, in comparison to biopsies obtained earlier. The engineered bone covered the surface of the bone substitute material but also grew out typical structures of cancellous bone tissue without a core of BioOss. The amount of induced bone tissue was 32% in the biopsy. In addition, the soft tissue showed an alignment of the connective tissue fibres parallel to the trabecular bone. Increasing time and mechanical forces at the mandible led to an increased amount of mineralized tissue and remodelling of the connective tissue fibres after transplantation. Further research should focus on developing advanced scaffold materials, as the outer titanium mesh cage leads to complications.

Total en bloc spondylectomy for spinal tumors of the fourth lumbar spine via a posterior approach: our clinical experience

Objective To study the feasibility and safety of total en bloc spondylectomy (TES) for bone tumors of the fourth lumbar spine and evaluate the clinical outcomes. Methods From March 2011 to December 2013, 21 patients undergone total en bloc spondylectomy in posterior-only approach were retrospectively reviewed. The patients included 9 males and 12 females, with a mean age of 47.1±15.6 years old (range, 15-71 years old). This series included 12 cases of primary bone tumors and 9 cases of solitary metastases. Preoperative evaluation according to clinical, imaging and pathologic features was performed meticulously to select patients. The length of surgery, estimated blood loss, surgical margins, instrumentation failure, perioperative complications, Frankel scale, visual analogue scale (VAS) for pain, local control rate and overall survival were reviewed and analyzed. Results Total en bloc spondylectomy was performed successfully in all patients. Average operative time and estimated blood loss were 297.6±44.6 min (range, 225-420 min) and 2 247.1±904.5 ml (range, 900-4100 ml), respectively. The mean follow-up time was 50.4±17.1 mons (range, 24-79 mons). All patients encountered nerve roots stretch and 5 patients (23.8%) showed lower extremeties neurological dysfunction. All of them improved in 2-4 weeks postoperatively and recovered completely at 6-month follow-up. Cerebrospinal fluid leak was found in 4 patients (19.0%). The VAS score was 1.5±1.4 at post-operation, which was significantly lower than the 6.2±1.6 in average at operation (P=0.008). Three patients with metastatic tumors died during the follow-up. Titanium mesh cage subsidence was observed in 7 patients (33.3%). No implant failure was occurred during the follow-up. Conclusion Total en bloc spondylectomy for tumors of the fourth lumbar spine in a posterior-only approach is feasible. However, there are many intraoperative neurological complications and the indications for TES are extremely limited. Key words: Lumbar spine; Spinal neoplasm; Surgical procedure; Treatment outcome

Management of extra-articular segmental defects in long bone using a titanium mesh cage as an adjunct to other methods of fixation: a multicentre report of 17 cases.

This study reviews the use of a titanium mesh cage (TMC) as an adjunct to intramedullary nail or plate reconstruction of an extra-articular segmental long bone defect. A total of 17 patients (aged 17 to 61 years) treated for a segmental long bone defect by nail or plate fixation and an adjunctive TMC were included. The bone defects treated were in the tibia (nine), femur (six), radius (one), and humerus (one). The mean length of the segmental bone defect was 8.4 cm (2.2 to 13); the mean length of the titanium mesh cage was 8.3 cm (2.6 to 13). The clinical and radiological records of the patients were analyzed retrospectively. The mean time to follow-up was 55 months (12 to 126). Overall, 16 (94%) of the patients achieved radiological filling of their bony defect and united to the native bone ends proximally and distally, resulting in a functioning limb. Complications included device failure in two patients (12%), infection in two (12%), and wound dehiscence in one (6%). Four patients (24%) required secondary surgery, four (24%) had a residual limb-length discrepancy, and one (6%) had a residual angular limb deformity. A titanium mesh cage is a useful adjunct in the treatment of an extra-articular segmental defect in a long bone. Cite this article: Bone Joint J 2018;100-B:646-51.

Anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage for cervical spondylotic myelopathy: A minimum 5-year follow-up study.

Anterior cervical corpectomy and fusion (ACCF) is an effective surgical technique for cervical spondylotic myelopathy (CSM). However, no data exist regarding long-term outcomes after ACCF with the dynamic cervical plate for CSM. This study aimed to provide minimum 5-year clinical and radiographic outcomes of anterior corpectomy and reconstruction using dynamic cervical plate and titanium mesh cage (TMC) for CSM.Thirty-five patients who underwent single- or 2-level ACCF with dynamic cervical plate and TMC for the treatment of CSM were retrospectively investigated. The Japanese Orthopedic Association (JOA) score was used to assess the clinical outcome. Radiographic evaluations included TMC subsidence, fusion status, cervical lordosis, segmental angle, and segmental height.Twenty-eight patients underwent single-level and 7 patients underwent 2-level corpectomy with a mean follow-up period of 69.5 months. The average preoperative JOA score was 11.3 ± 3.0 and improved significantly to 14.2 ± 2.0 at the last follow-up (P < .001). Both cervical lordosis (P = .013) and segmental angle (P = .001) were significantly increased toward lordosis at the last follow-up. The TMC subsidence rate was 31.4% (n = 11) at the last follow-up. There was no significant difference in JOA recovery rate between subsidence and no subsidence group (P = .43). All patients obtained solid fusion at 1-year follow-up.Anterior corpectomy and reconstruction with dynamic cervical plate and TMC might be an effective method for the treatment of CSM at a minimum 5-year follow-up. It can maintain or restore cervical sagittal alignment. Subsidence of the TMC did not influence the clinical outcome.

Posterior-only Hemivertebra Resection With Anterior Structural Reconstruction With Titanium Mesh Cage and Short Segmental Fusion for the Treatment of Congenital Scoliokyphosis: The Indications and Preliminary Results.

Perspective study. To evaluate indications and preliminary results of posterior hemivertebra resection with anterior structural reconstruction with titanium mesh cage and short segmental fusion. There exist a lot of reports on posterior hemivertebra resection for the early surgical intervention of congenital scoliosis because of hemivertebra. However, a few reports describe the procedure of the anterior structural reconstruction after posterior hemivertebra resection. In this study, 18 selected children of mean age 5.4 years (range, 2-12 yrs) with scoliokyphosis because of hemivertebra were treated with posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion. They were followed for an average of 37.1 (24-85) months. Radiograghs, operative reports, and patient charts were studied to evaluate the correction and complications. Average fused segments were 1.67 (1-3). The segmental scoliosis was 40.1° before surgery, 4.1° postsurgery, and 5.7° at the latest the follow up. Moreover, the segmental kyphosis (difference to normal segmental alignment) was improved from 27.6° to 3.9°. The correction of the compensatory cranial and caudal curve was 74.7% and 82.4%. The trunk shift improved from 17.7 mm to 5.3 mm. No complications occurred until the latest follow up. Posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion is a reliable procedure for selected patients with scoliokyphosis because of hemivertebra. A structural reconstruction is essential to the avoidance of overcorrection of the segmental scoliosis and resultant postoperative coronal imbalance with limited fused levels in some patients, increasing chances of short segmental fusion and saving mobile segments. As a fulcrum, anterior reconstruction with a titanium mesh cage could help to improve the correction of segmental kyphosis. Furthermore, the cage may help to stabilize the level of hemivertebra resection like a structural autograft, enhancing the postoperative stability and decreasing the stress of the pedicle and implants. 4.

Treatment of multiple segments of thoracolumbar tuberculosis using posterior unilateral debridement with bone graft and internal fixation

To explore the effectiveness and related issues in the treatment of multiple segments of thoracolumbar tuberculosis through posterior unilateral debridement with bone graft and internal fixation. The clinical data of 29 patients with multiple segments of thoracolumbar tuberculosis who met the selection criteria were retrospective analyzed between January 2012 and July 2015. There were 17 males and 12 females, with age of 21-62 years (mean, 37.4 years). Lesions contained 3-8 vertebral segments, including 3 segments in 6 cases, 4-6 segments in 17 cases, and 7-8 segments in 6 cases. The center lesions located at thoracic spine in 8 cases, lumbar spine in 10 cases, and thoracolumbar segment in 6 cases, and thoracic lumbar skip lesions in 5 cases. The complications included vertebral abscess in 7 cases, psoas major abscess in 6 cases, sacral spine muscle abscess in 7 cases, iliac fossa and the buttocks abscess in 1 case, spinal canal abscess in 2 cases. Preoperative neurological function was assessed according to the American Spinal Injury Association (ASIA) classification: 1 case of grade B, 3 cases of grade C, 8 cases of grade D, and 17 cases of grade E. The disease duration was 6-48 months (mean, 19.3 months). All the patients were treated with posterior unilateral transpedicular or transarticular debridement with bone graft fusion and internal fixation under general anesthesia. Pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), and sagittal Cobb angle were recorded and compared. Bridwell classification standard was used to evaluate bone graft fusion. According to the number and the center of the lesion, the necessity to placement of titanium mesh cage was analyzed. All the patients were followed up 18-30 months (mean, 24 months). Cerebrospinal fluid leakage occurred in 3 cases, intercostal neuralgia in 2 cases, wound unhealed and fistula formation in 1 case, and ofiliac fossa abscess recurred in 1 case, and all recovered after symptomatic treatment. During follow-up, no fracture or loosing of internal fixation was found and all the lesions were cured at last follow-up. According to Bridwell classification standard, bone graft achieved bony fusion during 4-9 months after operation. The VAS score, ODI, and Cobb angle at immediate after operation and at last follow-up were significantly improved when compared with preoperative ones ( P<0.05). At last follow-up, the neural function of all patients improved significantly when compared with preoperative one ( Z= -3.101, P=0.002). The ratio of no placement of titanium mesh cage was significantly higher in patients with more than 6 lesion segments (6/6, 100%) than in patients with less than 6 lesion segments (4/23, 17.4%) ( χ2=14.374, P=0.000). And the ratio of placement of titanium mesh cage was not significantly different between the patients with the different locations of center focus ( χ2=0.294, P=0.863). For treating multiple segments of thoracolumbar tuberculosis, the method of posterior unilateral debridement with bone graft and internal fixation can decrease the damage of posterior spinal structures and surgical trauma.

Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation

Abstract Background Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. Material and method A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. Results 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy ( n = 4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p = 0.801. The preoperative and 4-year postoperative Nurick was 3.28±0.48 and 3.14±1.21 respectively, with p = 0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p = 0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 mm respectively, with p = 0.0001. Conclusions Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nurick scale and NDI.

Single-Level Anterior Cervical Corpectomy and Fusion Using a New 3D-Printed Anatomy-Adaptive Titanium Mesh Cage for Treatment of Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: A Retrospective Case Series Study.

BackgroundThe aim of this study was to evaluate the clinical and radiological outcomes of the use of a new 3D-printed anatomy-adaptive titanium mesh cage (AA-TMC) for single-level anterior cervical corpectomy and fusion (ACCF) in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL).Material/MethodsWe retrospectively reviewed the records of 15 consecutive patients who underwent ACCF surgeries with AA-TMC implantation. The Japanese Orthopedic Association (JOA) scoring system, a visual analogue scale (VAS), the mean intervertebral height (MIBH) of the surgical segments, and the surgical segmental angle (SSA) were recorded preoperatively, immediately after surgery and at the final follow-up visit. The outcomes of these parameters at different time points were compared.ResultsSix months after ACCF surgery, solid bony fusions of the surgical level were achieved in all patients. The mean MIBH was 21.05±1.99 mm preoperatively, 27.51±1.44 mm immediately after surgery (P<0.05), and 26.85±1.25 mm at the last follow-up visit (P<0.05). At the last follow-up visit, none of the AA-TMCs exhibited severe subsidence (>3 mm). The mean SSA was 6.66±7.08° preoperatively, 14.03±2.3° immediately after surgery (P<0.05), and 15.09±2.1° at the final follow-up visit (P>0.05). The mean VAS and JOA scores were 6.6±1.26 and 10.47±2.07, respectively, preoperatively and 2.47±1.3 and 13.6±1.96 immediately after surgery, respectively (P<0.05). At the last follow-up visit, the mean VAS and JOA were further restored to 1.67±1.18 and 14.9±1.39, respectively (P<0.05).ConclusionsThe application of the AA-TMC in single-level ACCF significantly relieved symptoms of CSM and OPLL. The rational design of the AA-TMC restores the surgical segmental curvature, maintains the intervertebral height, and prevents postoperative subsidence-related complications.

Effects of Titanium Mesh Cage End Structures on the Compressive Load at the Endplate Interface: A Cadaveric Biomechanical Study.

BackgroundThis study aimed to evaluate whether obliquely angled and ring-shaped titanium mesh cage (TMC) end structures can improve the compressive load on the endplate interface in anterior cervical corpectomy and fusion (ACCF).Material/MethodsA total of 23 volunteers underwent cervical lateral x-ray. The oblique angle of the superior endplate was measured, which was used to construct the gradient of the TMC end. Forty-two fresh cadaveric vertebral bodies were harvested and randomly distributed among four TMC groups with different ends. The baseline indicators of bone mineral density and anteroposterior and transverse dimensions were recorded. The superior endplate was placed at an angle of 12° when performing uniaxial compression testing. The maximum loads of the four TMCs were assessed.ResultsThere were no significant differences among the groups regarding the baseline indicators. The conventional TMC had the lowest maximum load (1362.3±221.78 N, p<0.05), whereas the TMC with an obliquely end ring had the highest maximum load (2095.82±285.64 N, p<0.05). The maximum loads of the TMCs with oblique footprints and flat end ring were much higher than that of the conventional TMC (p<0.05) but significantly lower than that of the TMC with the obliquely end ring (p<0.05), with average values of 1806.91±246.98 N and 1725.3±213.33 N, respectively.ConclusionsBoth the ring shape and oblique angle of the TMC end contributed to an increase in compressive force and are advocated for use in TMC structure optimization to decrease the incidence of TMC subsidence in ACCF.

Anterior decompression and hybrid reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of three-level cervical spondylotic myelopathy

It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8months. The average operative time was 103±18.5min, and the average blood loss was 115±13.3mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively (P<0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.

Neurological complications of thoracic posterior vertebral column resection for severe congenital spinal deformities.

The risk of neurological injury during vertebral column resection is high. In this study, we investigated the incidence and risk factors for neurological complications when treating spinal deformities by thoracic posterior vertebral column resection (PVCR). Between 2008 and 2013, there were 62 consecutive patients (34 female patients and 28 male; the mean age: 16.3years, range 6-46years) treated with thoracic PVCR. We retrospectively reviewed the clinical records to obtain demographic and radiographic data, operative time, estimated blood loss (EBL, the ratio between circulating and lost blood), bleeding volume (the lost blood), number of vertebrae fused, number of vertebrae resected, usage of titanium mesh cage, and intraoperative neuromonitoring data. Multi-factor logistic regression was used to find the major risk factors for neurological complications. The average follow-up period was 46months (range 24-88months); no patients were lost to follow up. The average operative time was 524.8±156.8min (range 165.0-880.0min), the average bleeding volume was 2585±2210ml (100-9600ml), and the average estimated blood loss was 75.8% (9-278%). Ten patients (16.1%) developed post-operative neurological complications (nine transient and one permanent). Multi-factor logistic regression revealed that the risk factors for neurological complications were age ≥18years, pulmonary dysfunction, and EBL >50%. Thoracic PVCR can lead to satisfactory outcomes in the treatment of severe spinal deformities. Risk factors for neurological complications include the age over 18years, presence of pulmonary dysfunction, and EBL greater than 50%. The pulmonary dysfunction can be regarded as the most valuable indicator to measure the severity of the spine deformity.

Cement-augmented screws in a cervical two-level corpectomy with anterior titanium mesh cage reconstruction: a biomechanical study.

Biomechanical investigation. Cervical two-level corpectomies with anterior-only instrumentation are associated with a high rate of implant-related complications. These procedures, therefore, often require an additional dorsal instrumentation to prevent screw loosening. Cement augmentation of the anterior screws in two-level corpectomies might stabilize the construct, so that a second dorsal procedure could be avoided. To evaluate the screw anchorage in cervical anterior-only procedures, an ex vivo evaluation of the range of motion (ROM) in two-level corpectomies (C4 and C5), with and without cement augmentation of the anterior screws, was carried out in this study. Twelve human cervical cadaveric spines (C2-T1) were divided into two groups of six specimens each. Corpectomies were performed in C4 and C5, with grafting and anterior instrumentation with and without cement augmentation of the anterior screw-and-plate system (0.3-0.5mL cement/screw). Flexibility tests with pure moments (1.5Nm) were carried out before and after three cyclic loading periods of 5000 cycles with increasing eccentric forces (100, 200, and 300N). After corpectomy and instrumentation, the control group and the augmented group showed a significant reduction in ROM in comparison with the native states with average ROMs of 49% (±17%) and 24% (±10%), respectively (P=0.006). The ROM in the control group increased significantly in all motion directions in the course of cyclic loading and approached native values after the third cyclic loading period, with an overall ROM of 78% (±22%). In contrast, the augmented group maintained a significantly decreased ROM in all motion directions during cyclic loading, with a final ROM of 32% (±14%) after the third period of cyclic testing. Inter-group comparison demonstrated a significant difference between the two groups in the course of cyclic loading. The cement-augmented group outperformed the control group in all motion directions, with a significantly lower ROM after all three cyclic loading periods. A two-level corpectomy with cement-augmentation results in a significantly reduced ROM. In comparison with the conventional anterior screw-and-plate fixation, it represents a significantly stabilized two-level anterior construct. This might be a treatment option for patients with a two-level corpectomy associated with reduced bone mineral density, to avoid an additional dorsal instrumentation.

Resultados a 4 años de seguimiento del tratamiento del conducto cervical estrecho mediante corpectomía, malla de titanio y fijación anterior con placa

BackgroundCervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. Material and methodA prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. Results7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. ConclusionsDespite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI.

Efficacy of anterior column reconstruction in tuberculosis of the cervical spine with stand-alone titanium cage without anterior plating

Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone titanium cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone titanium mesh cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06° [standard deviation (SD) 10.92°], which improved to –5.51° (SD 77°) (P < 0.05). When comparing the visual analogue scores, there was also a statistically significant difference in pain improvement. All patients underwent single-stage radical debridement, decompression and instrumentation. Anterior column reconstruction was performed in all patients using a stand-alone titanium cage. The use of titanium cages effectively corrects sagittal deformity in the TB-affected spine with no donor site morbidity.

Risk factors of instrumentation failure after multilevel total en bloc spondylectomy.

Introduction: Multilevel total en bloc spondylectomy (TES) is required to secure oncologically adequate resection margins. However, no useful information has been reported for spinal reconstruction after multilevel TES. Therefore, this study set out to assess the clinical and radiological outcomes of spinal reconstruction after multilevel TES. Methods: Forty-eight patients treated with multilevel TES at our institute were included in the analysis. Reconstruction was achieved with posterior pedicle screw fixation and an anterior titanium mesh cage filled with iliac autograft in all cases. Spinal shortening was performed to increase spinal stability from the reconstruction. Instrumentation failure and radiological findings were evaluated with radiography and computerized tomography (CT). Results: After excluding one patient whose general condition was deteriorating, radiological evaluations of 47 patients were performed over a period of more than a year. The follow-up time was 17 to 120 months (mean: 70.2 months). Instrumentation failure occurred in one patient (5.9%) after thoracic multilevel TES, in 4 patients (25.0%) after thoracolumbar multilevel TES, and in 3 patients (42.9%) after lumbar multilevel TES. No instrumentation failure was observed in cervicothoracic cases. Cage subsidence (>2 mm) occurred in 30 patients (63.8%). In 22 of them, subsidence appeared on the CT one month after surgery. The risk factors of instrumentation failure included a multilevel TES below the thoracolumbar level and a long span of vertebral resection. There was no instrumentation failure in any of the 11 “disc-to-disc cutting” cases. Conclusions: This study identified the risk factors of instrumentation failure after multilevel TES. There is a high risk of instrumentation failure in cases of long vertebral resection below the thoracolumbar level. On the other hand, our reconstruction method can be successful for multilevel TES above the thoracic level.

Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only

PurposeTo analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. MethodsFrom September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60–68 years) at the time of surgery. The mean follow-up time was 40 months(range 26–68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle. ResultsThe spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8–38°) and decreased to 7.6° (range 1–18°) postoperatively. There was no significant loss of the correction at the latest follow-up. ConclusionsOur results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis.

The application of a new type of titanium mesh cage in hybrid anterior decompression and fusion technique for the treatment of continuously three-level cervical spondylotic myelopathy.

To evaluate the efficacy and safety of a new type of titanium mesh cage (NTMC) in hybrid anterior decompression and fusion method (HDF) in treating continuously three-level cervical spondylotic myelopathy (TCSM). Ninety-four cases who had TCSM and accepted the HDF from Jan 2007 to Jan 2010 were included. Clinical and radiological outcomes were compared between cases who had the NTMC (Group A, n=45) and traditional titanium mesh cage (TTMC, Group B, n=49) after corpectomies. Each case accepted one polyetheretherketone cage (PEEK) after discectomy. Mean follow-up were 74.4 and 77.3months in Group A and B, respectively (p>0.05). Differences in cervical lordosis (CL), segmental lordosis (SL), anterior segmental height (ASH) and posterior segmental height (PSH) between two groups were not significant preoperatively, 3-days postoperatively or at final visit. However, losses of the CL, SL, ASH and PSH were all significantly larger in Group B at the final visit, so did incidences of segmental subsidence and severe subsidence. Difference in preoperative Japanese Orthopedic Association (JOA), visual analog scale (VAS), neck disability index (NDI) or SF-36 between two groups was not significant. At the final visit, fusion rate, JOA, and SF-36 were all comparable between two groups, but the VAS and NDI were both significantly greater in Group B. For cases with TCSM, HDF with the NTMC and TTMC can provide comparable radiological and clinical improvements. But application of the NTMC in HDF is of advantages in decreasing the subsidence incidence, losses of lordosis correction, VAS and NDI.