Complications associated with cervical vertebral body replacement with expandable titanium cages

Our aim was to analyze complications and risk factors for cervical vertebral body replacement (VBR) with expandable titanium cages (ETC). Fifty patients; 22 women and 28 men, mean age 61years, undergoing cervical VBR from 2010 to 2015 were analyzed. Complications were stratified by hardware-association (HA). Univariate and multivariate logistic regression was used to identify independent risk factors. Single, two and three level corpectomies were performed in 32, 15 and 3 patients respectively. A circumferential approach was necessary in 16 cases. At mean follow-up (7.3 months) 66% of patients had recovered. Radiological data showed a significant distraction (2.60mm, p<0.0001) and lordosis (5°, p=0.001). Twenty-three patients experienced 42 complications; 18 HA, 24 non-HA and 24% needed revision surgery. The number of corpectomy levels and surgical approach significantly correlated with the risk of complications (p=0.001), especially non-HA complications (p=0.002). On multivariate analysis, only the number of corpectomy levels (p<0.02, odds ratio 5.48, 95% CI 1.31-22.91) was a significant predictor of complications. We conclude that ETC are efficacious devices for cervical spine VBR, however, when used for more than 1 level, the corpectomy complication rate significantly increases.