Omeis Ibrahim, Bekelis Kimon, Gregory Anthony, McGirt Matthew, Sciubba Daniel, Bydon Ali, Wolinsky J P, Gokaslan Ziya, Witham Timothy
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Orthopedics. 2010 Feb;33(2):87-92. doi: 10.3928/01477447-20100104-12.
Expandable cages have been used successfully to reconstruct the anterior spinal column in the treatment of traumatic, neoplastic, infectious, and degenerative spine disease. To the best of our knowledge, no studies report the results of the use of expandable cages in patients undergoing multilevel corpectomies for cervical spine metastatic disease. We report our experience with the use of expandable cages in this subgroup of patients.From August 2006 to May 2008, 5 patients presenting with myelopathy, pain, and/or radiculopathy secondary to metastatic disease of the cervical spine underwent multilevel cervical corpectomies and placement of expandable cages in our institution. All procedures were supplemented with an anterior cervical plate and with posterior instrumentation to achieve a 360 degrees fusion. A visual analog scale (VAS), Nurick grade, Frankel grade, American Spinal Injuries Association (ASIA) grade, and Ranawat grade were used to evaluate patients pre- and postoperatively. The mean follow-up period was 13.2 months. Three patients underwent a 2-level corpectomy, 1 a 3-level corpectomy, and 1 a 4-level corpectomy. Postoperative imaging studies showed that all patients had correction of preoperative kyphosis. The mean VAS score was reduced from 6.4 to 1. All other indices of spinal cord injury measured improved postoperatively or were stabilized. Postoperative imaging studies showed stable constructs in 4 patients.The use of expandable cages in multilevel corpectomies for the treatment of metastatic cervical spine disease appears to be a safe and effective way to reconstruct the anterior column of the cervical spine, preventing further neurologic deterioration.
可扩张椎间融合器已成功用于重建脊柱前路，治疗创伤性、肿瘤性、感染性和退行性脊柱疾病。据我们所知，尚无研究报道可扩张椎间融合器在接受多节段椎体次全切除治疗颈椎转移性疾病患者中的应用结果。我们报告我们在这一亚组患者中使用可扩张椎间融合器的经验。2006年8月至2008年5月，5例因颈椎转移性疾病继发脊髓病、疼痛和/或神经根病的患者在我院接受了多节段颈椎椎体次全切除并植入可扩张椎间融合器。所有手术均辅以颈椎前路钢板和后路内固定以实现360度融合。采用视觉模拟评分法（VAS）、Nurick分级、Frankel分级、美国脊髓损伤协会（ASIA）分级和Ranawat分级对患者进行术前和术后评估。平均随访期为13.2个月。3例患者接受了2节段椎体次全切除，1例接受了3节段椎体次全切除，1例接受了4节段椎体次全切除。术后影像学检查显示所有患者术前驼背均得到矫正。VAS评分平均从6.4降至1。所有其他测量的脊髓损伤指标术后均有改善或稳定。术后影像学检查显示4例患者内固定稳定。在多节段椎体次全切除术中使用可扩张椎间融合器治疗颈椎转移性疾病似乎是重建颈椎前路的一种安全有效的方法，可防止神经功能进一步恶化。
