title: Effect of posterior subsidence on cervical alignment after anterior cervical corpectomy and reconstruction using titanium mesh cages in degenerative cervical disease.
abstract: Subsidence after anterior cervical reconstruction using a titanium mesh cage (TMC) has been a matter of debate. The authors investigated and analyzed subsidence and its effect on clinical and radiologic parameters after cervical reconstruction using a TMC for degenerative cervical disease. Thirty consecutive patients with degenerative cervical spine disorders underwent anterior cervical corpectomy followed by reconstruction with TMC. Twenty-four patients underwent a single-level corpectomy, and six patients underwent a two-level corpectomy. Clinical outcomes were assessed using a Visual Analogue Scale (VAS), the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). Fusion status, anterior and posterior subsidence of the TMC, segmental angle (SA) and cervical sagittal angle (CSA) were assessed by lateral and flexion-extension radiographs of the neck. The mean follow-up period was 27.6 months (range, 24 to 49 months). The VAS, NDI and JOA scores were all significantly improved at the last follow-up. No instances of radiolucency or motion-related pseudoarthrosis were detected on radiographic analysis, yielding a fusion rate of 100%. Subsidence occurred in 28 of 30 patients (93.3%). The average anterior subsidence of the cage was 1.4 ± 0.9 mm, and the average posterior subsidence was 2.9 ± 1.2 mm. The SA and CSA at the final follow-up were significantly increased toward a lordotic angle. Anterior cervical reconstruction using TMC and plating in patients with cervical degenerative disease provides good clinical and radiologic outcomes. Cage subsidence occurred frequently, especially at the posterior part of the cage. Despite the prominent posterior subsidence of the TMC, SA and CSA were improved on final follow-up radiographs, suggesting that posterior subsidence may contribute to cervical lordosis.
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
authors: Jae-Won
authors: JW
authors: Jang
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea. Electronic address: jkl@chonnam.ac.kr.
authors: Jung-Kil
authors: JK
authors: Lee
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
authors: Jung-Heon
authors: JH
authors: Lee
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
authors: Hyuk
authors: H
authors: Hur
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
authors: Tae-Wan
authors: TW
authors: Kim
authors: Department of Neurosurgery, Chonnam National University Medical School & Research Institute of Medical Sciences, 671, Jebongno, Dong-gu, Gwangju 501-757, Republic of Korea.
authors: Soo-Han
authors: SH
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D004185:Disability Evaluation; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; D008141:Lordosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013526:Surgical Mesh; D014025:Titanium; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014025:Titanium
keywords: Cervical reconstruction; Corpectomy; Lordosis; Posterior subsidence; Titanium mesh cage