Outcome associated with use of winged expandable titanium cage following cervical corpectomy: an institutional experience

Abstract

In patients with spinal cord compression behind the cervical vertebra who presented with myelopathy, one of the treatment modalities is anterior cervical corpectomy followed by insertion of graft or implant. Autogenous bone graft has been the choice of implant for corpectomy in the past, but due to donor site complications, it has been majorly replaced with other implants like titanium made expandable and non-expandable cages. Studies on titanium made implants for cervical compressive myelopathy have mostly focused on expandable cages with separate plates. Studies on hybrid cages and winged expandable titanium cages with (WETC) are lacking, especially in patients with poor Nurick grade. Here, we present clinical outcomes and side effects of WETC use following cervical corpectomy in 81 participants from a tertiary care center from Eastern India with 6 months of follow-up. We observed a considerable improvement in clinical outcomes which was measured using Nurick grade as mean scores changed from 4.06 ± 0.85 during the pre-operative stage to 2.85 ± 1.16 post-operation (P < 0.05). There was also a considerable improvement in the pain status as in the pre-operative stage there were three patients with mild pain, 53 with moderate and 25 with severe pain, but post-operation there were 53 patients with mild pain, only two with moderate pain and none with severe pain (P < 0.00001). In these participants, we observed that post-surgical Nurick grade was not associated with age, gender or time since first symptoms but was strongly associated with pre-surgical Nurick grade at P < 0.05. With WETC (in situ plate), we were able to obtain good outcomes with less serious complication in patients with poor Nurick grade. As size of implant is prefixed and can be expanded in WETC, it takes relatively less time to insert, thus leading to shorter operative time. With good endplate preparation and avoiding over expansion of cage, WETC avoids complications.