Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection.
OBJECTIVE
The authors report their clinical experience with expandable cages used to stabilize the spine after vertebrectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR).


METHODS
Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20 degrees. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage.


CONCLUSIONS
The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.
Department of Neurosurgery, Stanford University Medical Center, Stanford, California 94305-5327, USA.
Issada
I
Thongtrangan
Raju S V
RS
Balabhadra
Hoang
H
Le
Jon
J
Park
Daniel H
DH
Kim
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology; D019245:Compressive Strength; D016208:Databases, Factual; D019299:Decompression, Surgical; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D019736:Prostheses and Implants; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D012189:Retrospective Studies; D033081:Shear Strength; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery*; D019415:Torque; D016896:Treatment Outcome