Subsidence of Titanium Mesh Cage: A Study Based on 300 Cases

Study Design A cohort study. Objective To clarify the risk factors for the subsidence of the titanium mesh cage (TMC) after anterior cervical corpectomy and fusion, and to discuss their clinical correlations. Summary of Background Data Fusion with TMC after anterior cervical corpectomy has become popular as an established treatment for cervical degenerative diseases, but postoperative TMC subsidence has often been reported in the literature. Methods A total of 300 patients with anterior cervical corpectomy and TMC fusion were included in the study, including 1-level corpectomy in 236 patients and 2-level corpectomy in 64. TMC subsidence, radiologic findings, and clinical results were evaluated in the 12-month follow-up period. Results TMC subsidence occurred in 239 (79.7%) cases, including mild subsidence (1 to 3 mm) in 182 (60.7%) and severe subsidence (>3 mm) in 57 (19.0%). Two-level corpectomy was more susceptible to severe subsidence, when compared with 1-level corpectomy (P<0.001). Japanese Orthopedic Association recovery rate for severe subsidence was significantly lower than that for no subsidence (P=0.010). Severe subsidence was correlated with subsidence-related complications, including neck pain, neurologic deterioration, and instrument failure. Conclusions TMC subsidence was a common phenomenon after anterior cervical corpectomy and fusion with TMC. Level of corpectomy was a unique risk factor for severe subsidence in this study, which might have led to bad clinical results and subsidence-related complications.

[1]  Young-su Park,et al.  Complications and Long-Term Follow-Up Results in Titanium Mesh Cage Reconstruction After Cervical Corpectomy , 2006, Journal of spinal disorders & techniques.

[2]  D. Cho,et al.  Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy. , 2006, Surgical neurology.

[3]  R. Bartels,et al.  Subsidence of Stand-alone Cervical Carbon Fiber Cages , 2006, Neurosurgery.

[4]  K. Tomita,et al.  The Transmission of Stress to Grafted Bone Inside a Titanium Mesh Cage Used in Anterior Column Reconstruction After Total Spondylectomy: A Finite-Element Analysis , 2005, Spine.

[5]  H. van Jonbergen,et al.  Anterior cervical interbody fusion with a titanium box cage: early radiological assessment of fusion and subsidence. , 2005, The spine journal : official journal of the North American Spine Society.

[6]  M. Daubs.  Early Failures Following Cervical Corpectomy Reconstruction With Titanium Mesh Cages and Anterior Plating , 2005, Spine.

[7]  A. Shad,et al.  Anterior correction of cervical kyphotic deformity: effects on myelopathy, neck pain, and sagittal alignment. , 2004, Journal of neurosurgery.

[8]  K. Shigenobu,et al.  Pitfalls of Anterior Cervical Fusion Using Titanium Mesh and Local Autograft , 2003, Journal of spinal disorders & techniques.

[9]  P. Narotam,et al.  Titanium mesh cages for cervical spine stabilization after corpectomy: a clinical and radiological study. , 2003, Journal of Neurosurgery.

[10]  C. Coimbra,et al.  Titanium cage reconstruction after cervical corpectomy. , 2003, Journal of neurosurgery.

[11]  T. Whitecloud,et al.  Complications of multilevel cervical corpectomies and reconstruction with titanium cages and anterior plating. , 2003, Journal of spinal disorders & techniques.

[12]  Thomas M. Reilly,et al.  Early Reconstruction Failures After Multilevel Cervical Corpectomy , 2003, Spine.

[13]  K. Riew,et al.  The Use of Titanium Mesh Cages in the Cervical Spine , 2002, Clinical orthopaedics and related research.

[14]  Riew Kd,et al.  The use of titanium mesh cages in the cervical spine. , 2002 .

[15]  T. Washio,et al.  An Experimental Study on the Interface Strength Between Titanium Mesh Cage and Vertebra in Reference to Vertebral Bone Mineral Density , 2001, Spine.

[16]  Chang-Hoon Jeon,et al.  Effect of Endplate Conditions and Bone Mineral Density on the Compressive Strength of the Graft–Endplate Interface in Anterior Cervical Spine Fusion , 2001, Spine.

[17]  W. Couldwell,et al.  Use of cylindrical titanium mesh and locking plates in anterior cervical fusion. Technical note. , 2001, Journal of neurosurgery.

[18]  L. Lenke,et al.  Analysis of Titanium Mesh Cages in Adults With Minimum Two-Year Follow-Up , 2000, Spine.

[19]  R. Holt,et al.  Anterior cervical reconstruction using titanium cages with anterior plating. , 1999, Spine.