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A hollow cylindrical PMMA strut for cervical spine reconstruction after cervical multilevel corpectomy
Jyi-Feng Chen1, Shih-Tseng Lee, Chieh-Tsai Wu
1Department of Neurosurgery, Neurospinal Section, Chang Gung University, Medical College and Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. chenjf@adm.cgmh.org.tw
Study Design:
Between January 2002 and December 2005, a prospective study was performed with 14 patients. The patients had cervical diseases and received more than 1 segment anterior cervical corpectomies.
Objectives:
We investigated the effectiveness of the hollow cylindrical polymethyl methacrylate (PMMA) strut with the autograft for fusion and reconstruction of the cervical spine after multiplelevel cervical corpectomy.
Summary Of Background Data:
We usually used the titanium mesh cage to reconstruct the cervical spine after cervical corpectomy. A significant number of poor outcomes were noted. Because the mesh cage is very hard, it sinks into the vertebral body without the cortex. It is also difficulty to assess the fusion status.
Methods:
A total of 14 patients (age range: 31 to 76 y) underwent anterior cervical corpectomy after fusion and reconstruction with cylindrical PMMA struts. Each patient was reinforced with anterior cervical plate fixation. Follow-up radiographic evaluation was comprised of plain lateral dynamic radiographs and computerized tomography (CT) scans. We evaluated the patients for cervical lordosis and vertebral body height on the basis of plain radiographs. The fusion status was evaluated with CT scans. Neurologic status was assessed preoperative and postoperatively using the Nurick's grading system.
Results:
: The mean follow-up was 48.2 months (range: 28 to 70 mo). All patients showed spinal stability at 6 months follow-up on the basis of plain lateral dynamic radiograph results. Thirteen patients showed neurologic improvement with complete bony fusion in the 24-month reconstructed CT scans. There were no complications related to the hollow cylindrical PMMA strut. One patient had loosened screws and required a second operation.
Conclusions:
The cylindrical PMMA strut provides solid fusion and increased cervical lordosis and vertebral body height. There are few complications associated with the use of this strut, and neurologic recovery is satisfactory. The hollow cylindrical PMMA strut, combined with an anterior cervical plate, is a very successful surgical construct in these patients after long-segmental cervical corpectomy.