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Expandable titanium cages produce a 91% fusion rate at 5 years follow-up

Clinical researchers applied the cages to treat thoracolumbar spine fractures.

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BRUSSELS — New study findings suggest that using expandable titanium cages to reconstruct the anterior column after traumatic spinal burst fractures produces good to excellent clinical and radiological results at 5 years follow-up.

Klaus J. Schnake, MD, and colleagues at Charité University in Berlin performed posterior stabilization, followed by anterior corpectomy and reconstruction, using expanding cages with cancellous bone graft in 80 patients with traumatic burst fractures of the thoracolumbar spine (T4-L5). At 5 years postop, investigators evaluated 45 patients (56%) using plain radiographs, CT scans, Oswestry scores and clinical examinations.

Schnake presented the study results at the 9th Annual Meeting of the Spine Society of Europe, here.

Postoperatively, Oswestry scores averaged 12 points and loss of correction averaged 2.4° due to minimal cage subsidence. "No cage showed a radiolucent line or instability in flexion or extension views," Schnake said.

Based on CT scans, 41 of the 45 patients (91%) evaluated achieved bony fusion. At the 5-year clinical examination, "96% of the patients were walking, and two-thirds of them had returned to work," he said.

There was a 6% complication rate, including one patient who suffered spleen damage and another who experienced an injury to the diaphragm. Schnake also cited one disadvantage: "When you extend in situ, you will lose a little bit of the bone," he said.

Schnake noted that his group's 5-year study boasts the longest follow-up thus far on the use of expandable titanium cages for traumatic burst fractures.

"We did not see any adjacent segment problems, and we found that combined anterior-posterior stabilization with expandable cages is a safe procedure with satisfactory radiological and clinical medium-term outcomes," he said.

The study was supported in part by Ulrich Medical of Ulm, Germany.

For more information:

• Orthopedics Today was unable to determine whether the investigators have a financial conflict of interest related to any product or company cited in this article.
• Schnake KJ, Khodadadyan-Klostermann C, Melcher I, Kandziora F. Expandable grafts for vertebral body replacement of fractures of the thoraco-lumbar spine. Clinical and radiological outcome after 5 years. #46. Presented at the 9th Annual Meeting of the Spine Society of Europe. Oct. 2-6, 2007. Brussels.