gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Cervical vertebral body replacement using expandable titanium cages with an integrated plate (ADDplus) – a retrospective single-center study

Meeting Abstract

  • H. Pape - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • E. Shiban - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • D. Kuhlen - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • M. Stoffel - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • F. Ringel - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München
  • B. Meyer - Neurochirurgische Klinik und Poliklinik, Klinikum Rechts der Isar, Technische Universität München

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMI.02.07

DOI: 10.3205/11dgnc182, URN: urn:nbn:de:0183-11dgnc1820

Published: April 28, 2011

© 2011 Pape et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Singel- or multi-level cervical corporectomies are regularly indicated for degenerative pathologies, tumors, trauma or inflammation. For vertebral body replacement and stabilization several options are available as autologous iliac crest, PEEK cages and expandable or non-expandable titanium cages with or without additional anterior plating. An altenative to a two-pieced cage plate construct are expandable cages with integrated plates as the ADDplus (Urich Medical). These systems offer the advantage of a convenient implantation, however, load sharing of cage and plate in this one piece construct is not possible. The present study summarizes our experience with this construct.

Methods: The departmental database was screened for cervical corpectomies followed by vertebral body replacement with the expandable titanium cage with integrated plate ADDplus. Demographic data and clinical parameters (diagnosis, operation time, clinical presentation, complications) were assessed retrospectively.

Results: Between 04/2006 and 11/2010, 29 patients (f = 16 ; m = 13; mean age 65 yrs) underwent 31 operations for cervical corporectomies and implantation of an expendable cage with integrated plate. Underlying pathologies were degenerative (20/29), tumors (6/29), spondylodiscitis (4/29) and trauma (1/29). 83% presented with pain prior to surgery, 72% with myelopathy, 63% had a motor weakness. A one-level corporectomy was performed in 12, a two-level corporectomy in 16 and a three-level corporectomy in 3 cases. An additional posterior stabilization was performed in 16 patients. Mean surgical time was 167 minutes (98 - 276 min). Complications occurred in 4 cases (13%, 1 temporary paresis, 1 sepsis & MOF, 1 epidural hemorrhage, 1 temporary paresis of the recurrent laryngeal nerve). Postoperative results indicated that 22 patients (92%) experienced pain reduction, 8 of the 18 patients with motor weakness had improved motor functions (44%), 7 of the 21 patients with myelopathy experienced an improvement of their symptoms (33%). 20 of the 29 patients were seen for follow-up. 70% showed additional pain reduction after 3 months, 50% had experienced improvements of motor weakness as well as myelopathy. There were two cases of implant failure requiring a surgical revision.

Conclusions: Cervical vertebral body replacement using an expandable titanium cage with integrated plate is feasible and safe. The present data on complication rates is comparable to other series of multilevel corpectomies. For a comparison of inferiority or superiority of ADDplus in comparison to other implants, prospective data acquisition is necessary.