Evaluation of anterior cervical reconstruction with titanium mesh cages versus nano-hydroxyapatite/polyamide66 cages after 1- or 2-level corpectomy for multilevel cervical spondylotic myelopathy: a retrospective study of 117 patients.
OBJECTIVE
To retrospectively compare the efficacy of the titanium mesh cage (TMC) and the nano-hydroxyapatite/polyamide66 cage (n-HA/PA66 cage) for 1- or 2-level anterior cervical corpectomy and fusion (ACCF) to treat multilevel cervical spondylotic myelopathy (MCSM).


METHODS
A total of 117 consecutive patients with MCSM who underwent 1- or 2-level ACCF using a TMC or an n-HA/PA66 cage were studied retrospectively at a mean follow-up of 45.28 ± 12.83 months. The patients were divided into four groups according to the level of corpectomy (1- or 2-level corpectomy) and cage type used (TMC or n-HA/PA66 cage). Clinical and radiological parameters were used to evaluate outcomes.


RESULTS
At the one-year follow-up, the fusion rate in the n-HA/PA66 group was higher, albeit non-significantly, than that in the TMC group for both 1- and 2-level ACCF, but the fusion rates of the procedures were almost equal at the final follow-up. The incidence of cage subsidence at the final follow-up was significantly higher in the TMC group than in the n-HA/PA66 group for the 1-level ACCF (24% vs. 4%, p = 0.01), and the difference was greater for the 2-level ACCF between the TMC group and the n-HA/PA66 group (38% vs. 5%, p = 0.01). Meanwhile, a much greater loss of fused height was observed in the TMC group compared with the n-HA/PA66 group for both the 1- and 2-level ACCF. All four groups demonstrated increases in C2-C7 Cobb angle and JOA scores and decreases in VAS at the final follow-up compared with preoperative values.


CONCLUSIONS
The lower incidence of cage subsidence, better maintenance of the height of the fused segment and similar excellent bony fusion indicate that the n-HA/PA66 cage may be a superior alternative to the TMC for cervical reconstruction after cervical corpectomy, in particular for 2-level ACCF.
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Yuan
Y
Zhang
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Zhengxue
Z
Quan
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Zenghui
Z
Zhao
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Xiaoji
X
Luo
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Ke
K
Tang
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Jie
J
Li
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Xu
X
Zhou
Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Dianming
D
Jiang
D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D017886:Durapatite / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D053761:Nanocomposites / Q000737:chemistry*; D009757:Nylons / Q000737:chemistry; D009984:Orthopedic Fixation Devices; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D013997:Time Factors; D014025:Titanium / Q000737:chemistry*; D016896:Treatment Outcome
D009757:Nylons; D017886:Durapatite; D014025:Titanium