Neurological outcomes after corpectomy with autologous grafts versus expandable titanium cages: A pilot study

Vertebral corpectomy is a common surgical technique for spinal decompression and fusion. This retrospective pilot study compares the neurological outcomes of corpectomy using autologous bone grafts versus expandable titanium cages.

In this retrospective pilot study of 40 patients, we compared autologous bone grafts versus expandable cages for single- or multi-level corpectomy. We assessed pre- and postoperative mJOA (Modified Japanese Orthopedic Association) scores. To account for baseline imbalances, we performed analysis of covariance (ANCOVA) adjusting for age and preoperative mJOA, and inverse probability of treatment weighting (IPTW) based on propensity scores. Outcomes included postoperative mJOA, ΔmJOA, responder rate (≥2-point improvement), and Hirabayashi recovery rate.

Both groups showed significant neurological improvement. Adjusted for preoperative mJOA, the ANCOVA model found that the titanium group presented significantly higher postoperative mJOA scores after adjustment (ANCOVA coefficient=+2.50, p=0.0007). IPTW-weighted regression showed a trend toward greater neurological improvement with titanium (coefficient=+1.75, p=0.092), with satisfactory covariate balance. Clinically meaningful recovery was observed in 100% of titanium cases versus 75% of autologous cases (p=0.064). The Hirabayashi recovery rate was also superior with titanium (mean 65.0%) compared to autologous grafts (mean 45.1%).

Both techniques provided similar and effective neurological outcomes after corpectomy. Our findings suggest that neurological recovery is more strongly influenced by the preoperative severity of the myelopathy than by the surgical system used. Both are viable options for corpectomy and warrant larger-scale studies.