Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Liljenqvist, Ulf; Lerner, Thomas; Bullmann, Viola; Hackenberg, Lars; Halm, H.; Winkelmann, Winfried

doi:10.1007/s00586-003-0614-z

Cited by 136 publications

(135 citation statements)

References 20 publications

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“…Thongtrangan et al [19] reported a 100 % fusion for 15 patients who underwent tumor resections, and Liljenqvist et al [20] reported the same rate in 20 patients who underwent placement of the cage in the treatment of osteomyelitis. Auguste et al [6] reported a 100 % fusion rate for 22 patients, in whom the cage was inserted for the treatment of spondylotic myelopathy in 16 of them.…”

Section: Fusion Ratementioning

confidence: 97%

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Zaïri

Aboukaïs²,

Thines³

et al. 2012

Eur Spine J

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Background In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment. Methods This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion-extension radiographs at 2 years. Results The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p \ 0.05). The mean kyphosis angle decreased from 17°to 2°at the last follow-up (p \ 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.Conclusion Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.

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Section: Fusion Ratementioning

confidence: 97%

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Zaïri

Aboukaïs²,

Thines³

et al. 2012

Eur Spine J

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show abstract

“…It is also obvious that the failure of conservative measures, compression of neural elements, mechanical derangement (instability, malalignment, severe bone destruction), and intractable pain demands surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment and correction of instability [7,8,18]. However, surgeons still discuss staging, surgical access, and usage of instrumentation or cages [3,14,15,20]. Furthermore, minimally invasive and endoscopic surgeries are being promoted [9,11].…”

mentioning

confidence: 99%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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Purpose and methods We reviewed the management, failure modes, and outcomes of 196 patients treated for infectious spondylodiscitis between January 1, 2000 and December 31, 2010, at the Spinal Unit, Aarhus University Hospital, Aarhus, Denmark. Patients with infectious spondylodiscitis at the site of previous spinal instrumentation, spinal metastases, and tuberculous and fungal spondylodiscitis were excluded. Results Mean age at the time of treatment was 59 (range 1-89) years. The most frequently isolated microorganism was Staphylococcus aureus. The lumbosacral spine was affected in 64 % of patients and the thoracic in 21 %. In 24 % of patients, there were neurologic compromise, four had the cauda equina syndrome and ten patients were paraplegic. Ninety-one patients were managed conservatively. Treatment failed in 12 cases, 7 patients required re-admission, 3 in-hospital deaths occurred, and 5 patients died during follow-up. Posterior debridement with pedicle screw instrumentation was performed in 75, without instrumentation in 19 cases. Seven patients underwent anterior debridement alone, and in 16 cases, anterior debridement was combined with pedicle screw instrumentation, one of which was a two-stage procedure. Re-operation took place in 12 patients during the same hospitalization and in a further 12 during follow-up. Two in-hospital deaths occurred, and five patients died during follow-up. Patients were followed for 1 year after treatment. Eight (9 %) patients treated conservatively had a mild degree of back pain, and one (1 %) patient presented with mild muscular weakness. Among surgically treated patients, 12 (10 %) had only mild neurological impairment, one foot drop, one cauda equine dysfunction, but 4 were paraplegic. Twenty-seven (23 %) complained of varying degrees of back pain. Conclusions Conservative measures are safe and effective for carefully selected patients without spondylodiscitic complications. Failure of conservative therapy requires surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment, and correction of instability. Surgeons should master various techniques to achieve adequate debridement, and pedicle screw instrumentation may safely be used if needed.

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“…This is true for the thoraco-lumbar region [7,14,16,18,19,24], as well as for the cervical spine [15][16][17]24]. Furthermore, a direct comparison between autologous iliac bone strut and cages did not show a difference in clinical and imaging outcomes [22].…”

Section: Discussionmentioning

confidence: 94%

“…Furthermore, a direct comparison between autologous iliac bone strut and cages did not show a difference in clinical and imaging outcomes [22]. Safe use of expandable titanium cages has been demonstrated for the thoraco-lumbar region [18,19], but has not been reported yet in detail for the cervical spondylitic spine. Figures depicting the use of expandable cages in cervical vertebral body replacement are given in the papers published by Lee [17] and Acosta [1] in 2004 without going into details.…”

Section: Discussionmentioning

confidence: 95%

“…The anterior approach was closed with vacuum assistance, and final anterior stabilization could be achieved after one scheduled revision of the VAC system on day 11. Because of the rigid posterior stabilization, we used expandable cages that are reported not to disturb the healing process in the spondylitic thoraco-lumbar spine [18,19] and the well-established Caspar plating with titanium plates and screws [3,4]. This led to safe and stable reconstruction and marked neurological amelioration.…”

Section: Discussionmentioning

confidence: 99%

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Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

et al. 2010

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Osteomyelitis of the cervical spine may lead to profound bony destruction. The presented case developed multilevel osteomyelitic destruction of the cervical spine after decompression due to cervical myelopathy. He could be cured by a multiple-stage procedure: step one: debridement and removal of all anterior implants with vacuum-assisted closure combined with dorsal instrumentation from C0 to T3; step two: anterior reconstruction with expandable titanium cages and plate. The patient regained walking with the aid of a walking frame. The following recommendations are given: multiple stage procedure, extensive debridement and stabilization via an anterior and posterior approach, use of titanium implants.

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Titanium cages in the surgical treatment of severe vertebral osteomyelitis

Cited by 136 publications

References 20 publications

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Failure modes in conservative and surgical management of infectious spondylodiscitis

Complex 360°-reconstruction and stabilization of the cervical spine due to osteomyelitis

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