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Comparison of Radiological and Clinical Outcomes between Expandable and Non-expandable Cages Following Cervical
Anand Kumar Das1, Devendra Kumar Purohit2, Ajay Gupta3
1Department of Neurosurgery, All India Institute of Medical Sciences, Patna, India.
Asian Spine Journal
|May 22, 2023
Summary
Expandable cages improve cervical spine alignment after corpectomy, but non-expandable cages show lower subsidence and higher fusion rates. This meta-analysis compares outcomes for both cage types in cervical spine surgery.
Area of Science:
- Spine Surgery
- Orthopedic Surgery
- Neurosurgery
Background:
- Anterior cervical corpectomy and fusion is a primary surgical treatment for cervical spine conditions.
- Expandable and non-expandable cages are alternatives to bone grafts, reducing donor site morbidity.
- The optimal cage type for cervical corpectomy remains debated due to conflicting study results.
Purpose of the Study:
- To compare the radiological and clinical outcomes of expandable versus non-expandable cages after anterior cervical corpectomy.
- To provide evidence-based guidance on cage selection for cervical spine fusion.
Main Methods:
- A meta-analysis of 26 studies involving 1,170 patients published between 2011 and 2021.
- Studies were identified through comprehensive searches of major electronic databases.
- Radiological outcomes (segmental angle, subsidence, displacement, fusion) and clinical outcomes (reoperation rate) were compared using forest plots.
Main Results:
- Expandable cages achieved a significantly greater mean change in segmental angle (6.7° vs. 3.0°).
- Expandable cages demonstrated a lower mean subsidence rate (6% vs. 41%).
- Non-expandable cages showed a higher mean fusion rate (98% vs. 93%) and lower displacement (5% vs. 29%), with a lower reoperation rate (2% vs. 16%).
Conclusions:
- Expandable cages offer superior segmental angle correction in cervical corpectomy.
- While non-expandable cages have higher subsidence rates, they are associated with better fusion and lower displacement, potentially impacting clinical outcomes favorably.
- Cage selection should consider the trade-offs between alignment correction and fusion/stability outcomes.
