Reconstruction with expandable cages after single- and multilevel corpectomies for spinal metastases: a prospective case series of 60 patients.
BACKGROUND
Expandable cages are widely used to reconstruct the spine after the removal of vertebral metastases. Long-term results, however, are lacking, and there is little information on reconstruction after multilevel corpectomies.


OBJECTIVE
To determine long-term outcome for reconstruction of the spine with expandable cages after single and multilevel corpectomies for spinal metastases.


METHODS
A prospective cohort study of 60 consecutive patients with spinal metastases treated with expandable cages.


METHODS
All patients were prospectively followed with regular clinical and radiographic evaluation. Outcome measures were the Frankel score, patients' self-reported recovery, radiological alignment of the spine, and neurologic plus biomechanical complications.


RESULTS
Sixty patients were treated with expandable cages in our hospital in a 5-year period with a maximum follow-up of 6 years. Single-level reconstruction was performed in 48 cases, 2-level in 8, and 3-level in 4. Postoperatively, the Frankel score had improved significantly (p=.03), the segment height had increased (p=.02), and, in severe cases of kyphosis (>20°), the regional angulation had been corrected compared with preoperatively (p<.001). Complication rate, however, was high (36.7%), in particular after multilevel reconstruction, in which three cases had to be reoperated years after the initial surgery; reasons for this were hardware failure, progressive kyphosis, and bronchial perforation. Good recovery was reported in 70% of all patients.


CONCLUSIONS
Expandable cages can be used successfully in reconstruction of the spine after single and multilevel corpectomies for spinal metastases. However, long-term complication rate is high. Promotion of bony fusion, prevention of soft-tissue damage, adequate posterior stabilization, and careful patient selection may reduce these complications.
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands. Electronic address: g.de.ruiter@mchaaglanden.nl.
Godard C W
GC
de Ruiter
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands.
Daniel J
DJ
Lobatto
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands.
Jasper F
JF
Wolfs
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands; Department of Neurosurgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
Wilco C
WC
Peul
Department of Neurosurgery, Medical Center Haaglanden, Lijnbaan 32, 2501 CK, The Hague, The Netherlands.
Mark P
MP
Arts
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology; D011446:Prospective Studies; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D012086:Reoperation; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome
Decompression; Spinal instrumentation; Spinal tumors; Stabilization; Surgery; Surgical procedure