Cervical Corpectomy and Reconstruction Using Titanium Mesh Cage with Anterior Plating for Multilevel Spondylotic Myelopathy

頸椎減壓後使用鈦合金椎籠及前位骨板重建來治療頸椎多節脊椎病變

高玉憲(Yu-Hsien Kao)；楊士階(Shih-Chieh Yang)；牛自健(Chi-Chien Niu)；陳文哲(Wen-Jer Chen)；于尚文(Shang-Won Yu)；杜元坤(Yuan-Kun Tu)

titanium mesh cage ； cervical plate ； multilevel cervical spondylotic myelopathy

Journal of Orthopaedic Surgery Taiwan

27卷2期（2010 / 06 / 01）

63 - 70

英文

Purpose: Because of the concern of donor site-related complications of autografts and the fusion rate of allografts, the substitute of the titanium mesh cages (TMC) in spinal surgery has been reported. Here we present our preliminary results of anterior interbody fusion using TM Cs for patients with multilevel cervical spondylotic myelopathy. Materials and Methods: Fifteen patients (6 females, 9 males) with multilevel cervical spondylotic myelopathy were enrolled. Patients underwent anterior reconstruction using TM Cs and local autologous bone grafts for corpectomy decompression and associated cervical plate fixation. Radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning were used for imaging studies. The Nurick Function Disability (Nurick) score was used to assess myelopathy severity, while the Japanese Orthopedic Association (JOA) score was adopted to compare clinical outcomes before and after surgery. Results: The mean postoperative follow-up was 35.1 months (range, 18-55). No major surgery-related complications were observed. The implant-related complication rate was 13.3%. All patients experienced functional improvement of at least 2 in Nurick score after surgery. The mean JOA score increased significantly from a mean of 9 (range, 7-13) before surgery to 14 (range, 11-16) at the final follow-up. The bony continuum between the vertebral body and TM C was verified by cervical CT in all patients 12 months postoperatively. Conclusion: TM C with concomitant use of an anterior cervical plate has value in the treatment of patients with multilevel cervical spondylotic myelopathy. It provides immediate strong anterior column support, correct kyphotic deformity, and avoids donor site morbidity. Purpose: Because of the concern of donor site-related complications of autografts and the fusion rate of allografts, the substitute of the titanium mesh cages (TMC) in spinal surgery has been reported. Here we present our preliminary results of anterior interbody fusion using TM Cs for patients with multilevel cervical spondylotic myelopathy. Materials and Methods: Fifteen patients (6 females, 9 males) with multilevel cervical spondylotic myelopathy were enrolled. Patients underwent anterior reconstruction using TM Cs and local autologous bone grafts for corpectomy decompression and associated cervical plate fixation. Radiography, magnetic resonance imaging (MRI), and computed tomography (CT) scanning were used for imaging studies. The Nurick Function Disability (Nurick) score was used to assess myelopathy severity, while the Japanese Orthopedic Association (JOA) score was adopted to compare clinical outcomes before and after surgery. Results: The mean postoperative follow-up was 35.1 months (range, 18-55). No major surgery-related complications were observed. The implant-related complication rate was 13.3%. All patients experienced functional improvement of at least 2 in Nurick score after surgery. The mean JOA score increased significantly from a mean of 9 (range, 7-13) before surgery to 14 (range, 11-16) at the final follow-up. The bony continuum between the vertebral body and TM C was verified by cervical CT in all patients 12 months postoperatively. Conclusion: TM C with concomitant use of an anterior cervical plate has value in the treatment of patients with multilevel cervical spondylotic myelopathy. It provides immediate strong anterior column support, correct kyphotic deformity, and avoids donor site morbidity.