Use of Titanium Mesh and Vertebral Autograft in the Reconstruction of Anterior Spinal Column

Jay Chun, MD, PhD
William S. Rosenberg MD (San Francisco, CA)

Introduction:

While autograft is optimal for spinal fusion, the harvesting of structural autograft has been associated with postoperative pain and complications. We present an alternative that provides biologically advantageous autograft with immediate structural stability, while avoiding known harvest site complications. The fusion rate, graft behavior and clinical outcomes of 20 patients who underwent anterior spinal reconstruction using this construct are reported.

Methods:

Twenty patients underwent anterior spinal reconstruction with titanium mesh/vertebral autograft from 1995–1999 (11 trauma, 6 degenerative, 4 tumor, 14 women, 11 men; 9 cervical, 10 thoracic, 6 lumbar). The mean age was 47 (range: 17–86). The number of vertebral bodies resected ranged from 1 to 5 (1–1 body, 16–2 bodies, 3–3 bodies, 2–4 bodies, 1–5 bodies). All patients received additional spinal instrumentation as part of the fixation.

Results:

Evidence of radiographic fusion was accomplished in all patients. Construct displacement was not observed in any of the patients, while two patients had minimal subsidence on follow up CT scans. Clinical non–union was not found and all patients had good or excellent outcome.

Conclusion:

The use of titanium mesh filled with autologous cancellous bone harvested from the vertebral body for anterior spinal column reconstruction obviates a separate structural autograft harvest site while still providing autograft fusion and immediate stability. This technique is safe, simple to use and mesh length can be easily modified during surgery. Titanium mesh/vertebral autograft reconstruction of the spine is an important tool in the spine surgeon's armamentarium.