Poor Fusion Rates following Cervical Corpectomy Reconstructed with an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

Abstract

BACKGROUND: Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers. OBJECTIVE: To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis. METHODS: We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up. RESULTS: There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P =. 02); a decrease in the Neck Disability Index average from 55% to 12% (P =. 009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P =. 01). There was a change in cervical lordosis (Cobb method) average from -9.3° to -15.1° (P =. 002), without significant loss of lordosis (P =. 63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays - 50% (n = 39/78) and using computed tomography (CT) - 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications. CONCLUSION: To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.