School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland; Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA; Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, Florida, USA.
World Neurosurg. 2021 May;149:249-264.e1. doi: 10.1016/j.wneu.2021.01.027. Epub 2021 Jan 28.
Expandable cages have been increasingly used in cervical and lumbar reconstructions; however, there is a paucity in the literature on how they compare with traditional nonexpandable cages in the cervical spine. We present a systematic review and meta-analysis, comparing the clinical and radiologic outcomes of expandable versus nonexpandable corpectomy cage use in the cervical spine.
A database search identified studies detailing the outcomes of expandable and nonexpandable titanium cage use in the cervical spine. These studies were screened using the PRISMA protocol. Fixed-effects and random-effects models were used with a 95% confidence interval. Two analyses were carried out for each outcome: one including all studies and the other including only studies reporting on exclusively 1-level and 2-level cases.
Forty-one studies were included. The mean change in segmental lordosis was significantly greater in expandable cages (all, 6.72 vs. 3.69°, P < 0.001; 1-level and 2-level, 6.81° vs. 4.31°, P < 0.001). The mean change in cervical lordosis was also significantly greater in expandable cages (all, 5.71° vs. 3.11°, P = 0.027; 1-level and 2-level, 5.71° vs. 2.07°, P = 0.002). No significant difference was found between the complication rates (all, P = 0.43; 1-level and 2-level, P = 0.94); however, the proportion of revisions was significantly greater in expandable cages (all, 0.06 vs. 0.02, P = 0.03; 1-level and 2-level, 0.08 vs. 0.01, P = 0.017).
The use of expandable cages may carry a modest improvement in radiologic outcomes compared with nonexpandable cages in the cervical spine; however, they may also lead to a higher rate of revisions based on our analyses.
可扩张 cage 已越来越多地用于颈椎和腰椎重建；然而，在颈椎中，可扩张 cage 与传统不可扩张 cage 相比的文献资料仍然很少。我们进行了一项系统评价和荟萃分析，比较了颈椎中可扩张和不可扩张椎体切除 cage 的临床和影像学结果。
数据库检索确定了详细描述颈椎中可扩张和不可扩张钛 cage 使用结果的研究。这些研究采用 PRISMA 方案进行筛选。使用 95%置信区间进行固定效应和随机效应模型。对每个结果进行了两次分析：一次包括所有研究，另一次仅包括专门报告 1 个和 2 个水平病例的研究。
共纳入 41 项研究。可扩张 cage 的节段性前凸角度的平均变化明显更大（全部，6.72 对 3.69°，P < 0.001；1 个和 2 个水平，6.81°对 4.31°，P < 0.001）。可扩张 cage 的颈椎前凸角度的平均变化也明显更大（全部，5.71°对 3.11°，P = 0.027；1 个和 2 个水平，5.71°对 2.07°，P = 0.002）。并发症发生率无显著差异（全部，P = 0.43；1 个和 2 个水平，P = 0.94）；然而，可扩张 cage 的翻修比例明显更高（全部，0.06 对 0.02，P = 0.03；1 个和 2 个水平，0.08 对 0.01，P = 0.017）。
与颈椎中的不可扩张 cage 相比，可扩张 cage 的使用可能在影像学结果上略有改善；然而，根据我们的分析，它们也可能导致更高的翻修率。
