Evaluation Of Clinical And Radiological Outcome Of A New Types Of Cervical Titanium Mesh Cage

Anterior cervical corpectomy and fusion (ACCF) has the following notable advantages:large stereoscopic eyes, ease of being operation, decompression thoroughly, effective treatment. Anterior cervical corpectomy and fusion has become one of the popular and important ways in the treatment of cervical diseases or injuries,especially in the treatment of patients with severe cervical disease,such as severe spinal cord compression,Long segment disease,ossification of posterior longitudinal ligament hypertrophy.Reconstruction of cevical stability is especially important in such a large defect operation, at the present time, Because of the extensive application of TMC, Its shortcomings gradually revealed, postoperative subsidence of TMC has been found in many patients with ACCF using TMC, and which could lead to loss of cervical lordosis and intervertebral height, and even more subsidence-related complications, including neck pain, neurologic deterioration and instrument failure. Although the subsidence is relation to the patients'age, sex, level of corpectomy, type of plate and using end caps ,The design defect of current TMC was also one of the most important reasons for this problem and could not be resolved by other salvage measurement. so on the basis of the study of defect of current TMC, we design a new type TMC which have been used in clinical.Objectives:To evaluate the clinical effect of a new type titanium mesh cage (TMC) in the procedure of anterior cervical corpectomy and fusion (ACCF). And to compare with the current TMC in the clinical and radiological outcomeMethods:we retrospectively analyzed the patients who received these two type of TMC between june 2009 and January 2010. the trial was separated into two parts.In part I,a total of 53 patients were treated by ACCF with the new type TMC. roentgenographs were taken postoperatively to observe intervertebral height and cervical alignment. the neurological function was evaluated by JOA,NDI,VAS scoring system. In part II, we selected a total of 113 patients with ACCF using the current or new TMC, comparison of clinical and radiological outcome of two different types of TMCResults:Part I: After follow up, the JOA,NDI,VAS score of postoperative patients show better, one year after operation , the score respectively is 15.1±0.2 points,2.6±1.2 points,12.9±3.4points , whiling the preoperative score respectively is 8.4±0.5points,7.1±1.4points,24.8±5.4 points. The mean cervical lordosis increased from preoperative 8. 2°± 1.4°to six month'13.9°±1.4°to one year'13.9°±1.4°. The mean intervertebral height increased from preoperative 22.3mm±0.8mm to ix month'24.1±0.5mm to one year'23.9±0.4mm Part II:At the last follow up of 12 months, the traditional TMC group lost intervertebral height by 1.7±0.4mm, and the lordosis was lost by 4.9°?0.6°, while the intervertebral height lost of the new TMC group was 0.4±0.5mm,and lordosis lost averaged 0.9°?0.7°, the difference between these two groups was statistically significant (P<0.01).The improvement rate of neual fuction calculated by JOA score of the traditional TMC group and new TMC group were 64.9%?3.7% and 67.1%?3.4% respectively,however,there is no statistical difference(p>0.05).Concerning to complications: Eight patients in the traditional TMC group suffered from long-term neck pain and shoulder pain, while 2 patient had recurrence of neurological symptoms, and another 2 patients suffered from screw breakage.New TMC group only had two patients with long-term neck pain and shoulder pain.Conclusions:The application of the new type TMC for ACCF can be helpful to avoid postoperative subsidence, and which is better than the one of the present. The new type TMC also has be proved to be favor of restoring the intervertebral height and cervical alignment for one level corpectomy patients, although the superiority to the current TMC immediate clinical outcome was not statistical significant, the radiological changes are definitely better the the current TMC, there is a tendency that the clinical superiority of the new operation would become more obvious during the follow up. We should also notice that having limitation in restoring the cervical alignment for two level corpectomy patients because of defects in its design.