title: Long-term biomechanical stability and clinical improvement after extended multilevel corpectomy and circumferential reconstruction of the cervical spine using titanium mesh cages.
abstract: METHODS
  Retrospective review of clinical case series.
  
  
  OBJECTIVE
  We present our experience with extended (> or =3 levels) anterior cervical corpectomy (EACC) and reconstruction.
  
  
  BACKGROUND
  Multilevel cervical corpectomy has traditionally been associated with increased graft-related complications and worse clinical outcomes compared with single-level procedures. Data specifically regarding corpectomies across 3 or more levels remains limited.
  
  
  METHODS
  Retrospective review of data on 20 patients who underwent anterior cervical corpectomies with titanium mesh cage reconstruction and supplemental posterolateral fixation across 3 or more levels of the cervical spine. Anteroposterior/lateral plain films were used to determine sagittal balance and cage subsidence. Fusion was defined as the lack of motion on flexion-extension radiographs. Patients underwent preoperative and postoperative clinical assessment using visual analog scores and Nurick grading.
  
  
  RESULTS
  Surgery was performed for spondylotic myelopathy in 15 patients, osteomyelitis in 4, and fracture in 1. Corpectomies were performed across an average of 3.4 levels. Average follow-up was 33 months. Local autograft was used in all cases except osteomyelitis, where allograft was used instead. Sagittal balance was improved or maintained in all patients and was not related to number of corpectomy levels. An average of 30.2 degrees of kyphosis correction was achieved in 9 patients. All patients demonstrated radiographic evidence of fusion without significant cage subsidence and no cases of instrumentation failure. Improvement in pain and functional scores occurred in all cases.
  
  
  CONCLUSIONS
  Circumferential reconstruction using titanium mesh cages after EACC can provide appropriate, biomechanically stable fixation and allows for significant correction of preexisting kyphosis. Supplemental posterior instrumentation may limit delayed cage subsidence and loss of sagittal balance after this procedure. EACC and circumferential reconstruction seems to be an effective treatment for symptomatic degenerative, traumatic, or infectious pathology involving 3 or more levels of the anterior cervical spine.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA. acostaf@neurosurg.ucsf.edu
authors.forename: Frank L
authors.initials: FL
authors.lastname: Acosta
authors.forename: Henry E
authors.initials: HE
authors.lastname: Aryan
authors.forename: Dean
authors.initials: D
authors.lastname: Chou
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D001860:Bone Plates; D016025:Bone Transplantation; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium