Arts Mark P, Peul Wilco C
Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands.
Neurosurgery. 2008 Sep;63(3):537-44; discussion 544-5. doi: 10.1227/01.NEU.0000325260.00628.DC.
Vertebral body reconstruction after corpectomy has become a common surgical procedure. The authors describe a prospectively followed case series of patients treated with expandable cages for various indications.
Sixty patients underwent single or multilevel corpectomy for degenerative stenosis (13 patients), herniated disc (7 patients), deformity (14 patients), traumatic fracture (3 patients), infection (1 patient), or tumor (22 patients). Six different expandable vertebral body systems were used in the cervical spine (41 patients), thoracic spine (15 patients), and lumbar spine (4 patients). All patients were evaluated clinically and radiographically.
Thirty-nine patients underwent single-level corpectomy, 18 patients underwent two-level corpectomy, and 3 patients underwent three-level corpectomy. Anterior reconstruction alone was performed in 30 patients; circumferential reconstruction was performed in 30 patients, 9 of whom underwent reconstruction through a posterior approach only. At the time of the final follow-up examination (mean, 9 mo), the Nurick grade improved significantly. Ninety-five percent of the patients maintained or improved their Frankel score and 67% had good clinical results. The regional angulation was corrected significantly (4.0 +/- 9.0 degrees, P = 0.002), and the segment height increased significantly (3.5 +/- 8.0 mm, P = 0.002). Bony fusion was achieved in 93% of the cases. Subsidence was documented in nearly half of the patients (1.4 +/- 2.0 mm) and was reduced after circumferential fusion (0.9 +/- 1.9 mm, P = 0.08). Eighteen patients (30%) had complications and 12 patients (20%) underwent revision surgery.
Expandable vertebral body replacement systems can provide solid anterior column constructs with restoration of height and sagittal alignment. Favorable clinical outcome was shown in most patients, although the complication and reoperation rates are rather high.
椎体次全切除术后椎体重建已成为一种常见的外科手术。作者描述了一系列前瞻性随访的患者病例，这些患者因各种适应证接受了可扩张椎间融合器治疗。
60例患者因退行性狭窄（13例）、椎间盘突出（7例）、畸形（14例）、创伤性骨折（3例）、感染（1例）或肿瘤（22例）接受了单节段或多节段椎体次全切除术。六种不同的可扩张椎体系统应用于颈椎（41例）、胸椎（15例）和腰椎（4例）。所有患者均接受了临床和影像学评估。
39例患者接受了单节段椎体次全切除术，18例患者接受了双节段椎体次全切除术，3例患者接受了三节段椎体次全切除术。30例患者仅行前路重建；30例患者行环形重建，其中9例仅通过后路进行重建。在末次随访时（平均9个月），Nurick分级显著改善。95%的患者Frankel评分维持或提高，67%的患者临床效果良好。局部成角得到显著矫正（4.0±9.0度，P = 0.002），节段高度显著增加（3.5±8.0毫米，P = 0.002）。93%的病例实现了骨融合。近一半的患者出现下沉（1.4±2.0毫米），环形融合后下沉减少（0.9±1.9毫米，P = 0.08）。18例患者（30%）出现并发症，12例患者（
