Article
Effectiveness of the carbon composite cage in cervical corpectomy
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Published: | May 4, 2005 |
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Outline
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Objective
Cervical corpectomies remain a challenge to reconstruct the anterior column and maintain stability. Tricortical grafts are biologically satisfactory, but remain a source of morbidity and pain at the harvest site. Metallic implants achieve primary stability, but their radio-opaqueness makes the visualization of the osseous fusion difficult. We present a cervical corpectomy series using a carbon composite (Osta-pek®) cage, which provides primary stability, radiolucency to permit objective evaluation of fusion.
Methods
Cervical corpectomies were performed on sixty four patients for different cervical pathologies. Three cases with corporectomy at two levels and height cases with discetomy above or below. It was performed systematically an anterior cervical approach in right side. All cages were filled with autologous bone (corpectomy fragments and/or cancellous iliac fragments). Graft fusion was estimate on cervical X-ray (lateral incidence) performed on days 1, 8, 30, 60, 90, 180, 360 post-op. Mean follow-up is 16.4 months. Among last 15 cages, 5 were the second generation, with dome as superior plate.
Results
All patients demonstrated a radiographic fusion through the entire implant at 90 days. Neurology improved for all myelopathy cases. Cervico-bracial neuralgia cases improved, except two cases. No cage migration was observed. Four cages settled into the inferior endplate due to either osteoporosis or perhaps excessive distraction. No post-op neurological damage for patients with myelopathy. New generation cage has shown a better position (cervical spine axis).
Conclusions
Carbon composite cage is a good alternative to tricortical graft. Good primary stability of the anterior column. All cages were constructed in long carbon fibres Osta-Pek with the predominant orientation of the fibres in sagittal plane. This is similar to the orientation of the trabeculae in a vertebral body.
Radio transparency with minimal artefact for MRI and CT-scan permit a good evaluation of bony fusion. This fusion is obtained with a minimal graft (corporectomy). New generation cage should be better because of easy orientation in the right cervical spine axis.