Anterior Cervical Fusion with Cages

The use of cages for reconstruction after anterior cervical discectomy or corpectorny should allow the use of autograft while minimizing donor site requirements, decrease the risks of graft collapse and extrusion, shorten surgical times, and improve fusion rate.

Methods:

For the past 30 months, we have used titanium cages exclusively for anterior cervical fusions after discectomy or corpectomy. More than I 00 cases have been performed, 51 of which have 1 8–30 months of follow–up. With the exception of corpectomies for malignant tumor, all cases used autologous cancellous bone harvested percutaneously through a 1cm incision from the ilium or manubrium after discectomy or local bone after corpectomy. 92% of cases also employed anterior cervical plates. 19 single level discectomies, 31 multilevel discectomies and 52 corpectomies have been performed for degenerative –spondylosis (79), acute trauma (13), tumor (8), and infection (2). No postoperative orthoses are used except in cases of marked osteoporosis in which collars are applied for 12 weeks.

Results:

There have been no deaths, neurologic injuries, infections, or reoperations. There have been two cases in which multilevel corpectomy cages have telescoped into the caudal vertebra despite plate fixation – both after tumor resections in the face of radiation and steroid therapy. Both were salvaged with halo orthoses without further surgery. In three cases in which cages were used without anterior plates, postoperative settling led to collapse of disc height and mild kyphosis. Fusion status is very difficult to judge using metal cages but there are no apparent pseudarthoses.

Conclusion:

Cervical interbody cages eliminate the need for distal graft harvest after corpectomy for non–malignant disease, minimize the need for distal graft harvest after discectomy, minimize the risks of graft collapse or extrusion, and appear to satisfactorily incorporate when used with autologous local or distal cancellous bone. Further research with radiolucent or fully bioresorbable devices is warranted.