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Clinical and radiological outcomes of one-level cervical corpectomy with an expandable cage for three-column uncomplicated subaxial type «B» injures: a multicenter retrospective study

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Abstract

Purpose

To evaluate the clinical and radiological results of the operative management of three-column uncomplicated type «B» subaxial injures treated with a one-level cervical corpectomy with an expandable cage.

Methods

This study included 72 patients with a three-column uncomplicated type «B» subaxial injures who met the inclusion criteria, underwent a one-level cervical corpectomy with an expandable cage at one of three neurosurgical departments between 2005 and 2020, and were followed up for clinical and radiological outcomes at a minimum 3-yr follow-up.

Results

There was a decrease in the VAS pain score from an average of 80 mm to 7 mm (p = 0.03); a decrease in the average NDI score from 62 to 14% (p = 0.01); excellent and good outcomes according to Macnab’s scale were 93% (n = 67/72). There was an average change in the cervical lordosis (Cobb method) from −9.10 to −15.40 (p = 0.007), without significant loss of lordosis (p = 0.27). There was no significant degeneration of the adjacent levels by 3 years post-op. The fusion rate, using the Cervical Spine Research Society criteria, was poor: it was 62.5% (n = 45/72), and using the CT criteria, it was 65.3% (n = 47/72). 15.4% patients (n = 11/72) suffered complications. Statistical difference between the fusion and pseudoarthrosis (according to X-ray criteria) subgroups showed that there were no statistically significant differences in the smoking status, diabetes, chronic steroid use, cervical injury level, subtypes of AO type B subaxial injuries and types of expandable cage systems.

Conclusions

One-level cervical corpectomy with an expandable cage, despite a poor fusion rate, can be considered a feasible and relatively safe method for treating three-column uncomplicated subaxial type «B» injures, with the benefit of immediate stability, anatomical reduction, and direct decompression of the spinal cord. While no one in our series had any catastrophic complications, we did note a high complication rate.

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References

  1. Witiw CD, Fehlings MG (2015) Acute spinal cord injury. J Spinal Disord Tech 28(6):202–210. https://doi.org/10.1097/BSD.0000000000000287

    Article  PubMed  Google Scholar 

  2. Grassner L, Wutte C, Klein B, Mach O, Riesner S, Panzer S, Vogel M, Bühren V, Strowitzki M, Vastmans J, Maier D (2016) Early decompression (< 8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma 33(18):1658–1666. https://doi.org/10.1089/neu.2015.4325

    Article  PubMed  Google Scholar 

  3. Wilson JR, Vaccaro A, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R, Okonkwo DO, Fehlings MG (2013) The impact of facet dislocation on clinical outcomes after cervical spinal cord injury: results of a multicenter North American prospective cohort study. Spine (Phila Pa 1976) 38(2):97–103. https://doi.org/10.1097/BRS.0b013e31826e2b91

    Article  PubMed  Google Scholar 

  4. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, Kandziora F, Fehlings MG, Dvorak MF, Aarabi B, Rajasekaran S, Schroeder GD, Kepler CK, Vialle LR (2016) AOSpine subaxial cervical spine injury classification system. Eur Spine J 25(7):2173–2184. https://doi.org/10.1007/s00586-015-3831-3

    Article  PubMed  Google Scholar 

  5. Divi SN, Schroeder GD, Oner FC, Kandziora F, Schnake KJ, Dvorak MF, Benneker LM, Chapman JR, Vaccaro AR (2019) AOSpine-spine trauma classification system: the value of modifiers: a narrative review with commentary on evolving descriptive principles. Global Spine J 9(1 Suppl):77S-88S. https://doi.org/10.1177/2192568219827260

    Article  PubMed  PubMed Central  Google Scholar 

  6. Joaquim AF, Lee NJ, Riew KD (2021) Circumferential operations of the cervical spine. Neurospine 18(1):55–66. https://doi.org/10.14245/ns.2040528.264

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sethy SS, Ahuja K, Ifthekar S, Sarkar B, Kandwal P (2021) Is anterior-only fixation adequate for three-column injuries of the cervical spine? Asian Spine J 15(1):72–80. https://doi.org/10.3161/asj.2019.0225

    Article  PubMed  Google Scholar 

  8. Wu HH, Tang T, Yu X, Pang QJ (2018) Stability of two anterior fixations for three-column injury in the lower cervical spine: biomechanical evaluation of anterior pedicle screw-plate fixation. J Int Med Res 46(4):1455–1460. https://doi.org/10.1177/0300060517734687

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yang JS, Liu JJ, Liu P, Zhang ZX, Liu TJ, Tuo Y, Yan L, Zhang ZP, Zhang HP, Chen H, Hao DJ (2020) Can posterior ligament structure be functionally healed after anterior reduction and fusion surgery in patients with traumatic subaxial cervical fracture-dislocations? World Neurosurg 134:e243–e248. https://doi.org/10.1016/j.wneu.2019.10.045

    Article  PubMed  Google Scholar 

  10. Madan A, Thakur M, Sud S, Jain V, Singh Thakur RP, Negi V (2019) Subaxial cervical spine injuries: outcomes after anterior corpectomy and instrumentation. Asian J Neurosurg 14(3):843–847. https://doi.org/10.4103/ajns.AJNS_331_17

    Article  PubMed  PubMed Central  Google Scholar 

  11. Abdelgawaad AS, Metry ABS, Elnady B, El Sheriff E (2021) Anterior cervical reduction decompression fusion with plating for management of traumatic subaxial cervical spine dislocations. Global Spine J 11(3):312–320. https://doi.org/10.1177/2192568220903741

    Article  PubMed  Google Scholar 

  12. Sonawane D, Dave H, Savant S, Garg B, Bangalore S, Chandanwale A (2021) Cervical corpectomy in delayed presentation of irreducible cervical dislocation: experience with eight cases. Br J Neurosurg. https://doi.org/10.1080/02688697.2021.1885619

    Article  PubMed  Google Scholar 

  13. Dvorak MF, Fisher CG, Fehlings MG, Rampersaud YR, Oner FC, Aarabi B, Vaccaro AR (2007) The surgical approach to subaxial cervical spine injuries: an evidence-based algorithm based on the SLIC classification system. Spine (Phila Pa 1976) 32(23):2620–2629. https://doi.org/10.1097/BRS.0b013e318158ce16

    Article  PubMed  Google Scholar 

  14. Kirshblum S, Snider B, Rupp R, Read MS; International Standards Committee of ASIA and ISCoS (2020) Updates of the international standards for neurologic classification of spinal cord injury: 2015 and 2019. Phys Med Rehabil Clin N Am 31(3):319–330. https://doi.org/10.1016/j.pmr.2020.03.005

    Article  Google Scholar 

  15. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26(17):1873–1878. https://doi.org/10.1097/00007632-200109010-00011

    Article  CAS  PubMed  Google Scholar 

  16. Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB, Haughton VM (2000) The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine (Phila Pa 1976) 25(23):3036–3044. https://doi.org/10.1097/00007632-200012010-00011

    Article  CAS  PubMed  Google Scholar 

  17. Rhee JM, Chapman JR, Norvell DC, Smith J, Sherry NA, Riew KD (2015) Radiological determination of postoperative cervical fusion: a systematic review. Spine (Phila Pa 1976) 40(13):974–991. https://doi.org/10.1097/BRS.0000000000000940

    Article  PubMed  Google Scholar 

  18. Vu C, Gendelberg D (2020) Classifications in brief: AO thoracolumbar classification system. Clin Orthop Relat Res 478(2):434–440. https://doi.org/10.1097/CORR.0000000000001086

    Article  PubMed  Google Scholar 

  19. Lee DY, Park YJ, Song MG, Kim KT, Kim DH (2021) Comparison of anterior-only versus combined anterior and posterior fusion for unstable subaxial cervical injuries: a meta-analysis of biomechanical and clinical studies. Eur Spine J 30(6):1460–1473. https://doi.org/10.1007/s00586-020-06704-0

    Article  PubMed  Google Scholar 

  20. Yoon JW, Tavanaiepour K, Tyler A, Keshavarzi S (2016) Management of severe traumatic flexion-distraction injuries in a multisystem trauma patient: a case report. Trauma Case Rep 5:18–23. https://doi.org/10.1016/j.tcr.2016.09.009

    Article  PubMed  PubMed Central  Google Scholar 

  21. Ren C, Qin R, Wang P, Wang P (2020) Comparison of anterior and posterior approaches for treatment of traumatic cervical dislocation combined with spinal cord injury: minimum 10-year follow-up. Sci Rep 10(1):10346. https://doi.org/10.1038/s41598-020-67265-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Rizzolo SJ, Piazza MR, Cotler JM, Balderston RA, Schaefer D, Flanders A (1991) Intervertebral disc injury complicating cervical spine trauma. Spine (Phila Pa 1976) 16(6 Suppl):S187–S189. https://doi.org/10.1097/00007632-199106001-00002

    Article  CAS  PubMed  Google Scholar 

  23. Byvaltsev VA, Kalinin AA, Aliyev MA, Azhibekov NO, Shepelev VV, Riew KD (2021) Poor fusion rates following cervical corpectomy reconstructed with an expandable cage: minimum 2-year radiographic and clinical outcomes. Neurosurgery 89(4):617–625. https://doi.org/10.1093/neuros/nyab240

    Article  PubMed  PubMed Central  Google Scholar 

  24. Elder BD, Lo SF, Kosztowski TA, Goodwin CR, Lina IA, Locke JE, Witham TF (2016) A systematic review of the use of expandable cages in the cervical spine. Neurosurg Rev 39(1):1–11. https://doi.org/10.1007/s10143-015-0649-8

    Article  PubMed  Google Scholar 

  25. Pojskic M, Saβ B, Nimsky C, Carl B (2020) Application of an expandable cage for reconstruction of the cervical spine in a consecutive series of eighty-six patients. Medicina (Kaunas) 56(12):642. https://doi.org/10.3390/medicina56120642

    Article  PubMed  Google Scholar 

  26. Tasiou A, Giannis T, Brotis AG, Siasios I, Georgiadis I, Gatos H, Tsianaka E, Vagkopoulos K, Paterakis K, Fountas KN (2017) Anterior cervical spine surgery-associated complications in a retrospective case-control study. J Spine Surg 3(3):444–459. https://doi.org/10.21037/jss.2017.08.03

    Article  PubMed  PubMed Central  Google Scholar 

  27. Schleicher P, Kobbe P, Kandziora F, Scholz M, Badke A, Brakopp F, Ekkerlein H, Gercek E, Hartensuer R, Hartung P, Jarvers JS, Matschke S, Morrison R, Müller CW, Pishnamaz M, Reinhold M, Schmeiser G, Schnake KJ, Stein G, Ullrich B, Weiss T, Zimmermann V (2018) Treatment of injuries to the subaxial cervical spine: recommendations of the spine section of the German society for orthopaedics and trauma (DGOU). Global Spine J 8(2 Suppl):25S-33S. https://doi.org/10.1177/2192568217745062

    Article  PubMed  PubMed Central  Google Scholar 

  28. Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves ÓL (2020) Subaxial cervical spine injuries: WFNS spine committee recommendations. Neurospine 17(4):737–758. https://doi.org/10.14245/ns.2040368.184

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia

    Vadim A. Byvaltsev, Andrei A. Kalinin, Bair B. Sanzhin, Alexander V. Kukharev & Valerii V. Shepelev

  2. Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia

    Vadim A. Byvaltsev & Andrei A. Kalinin

  3. Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia

    Vadim A. Byvaltsev

  4. Department of Neurosurgery, New Jersey Medical School, Rutgers University, New York, USA

    Evgenii G. Belykh

  5. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan

    Marat A. Aliyev & Yermek K. Dyussembekov

  6. Department of Neurosurgery, City Clinical Hospital No. 7, Almaty, Kazakhstan

    Marat A. Aliyev

  7. Department of Neurosurgery, 1477 Clinical Hospital, Vladivostok, Russia

    Valerii V. Shepelev

  8. Department of Orthopedic Surgery, Columbia University, New York, NY, USA

    K. Daniel Riew

  9. Department of Neurological Surgery, Weill Cornell Medical School, New York, USA

    K. Daniel Riew

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  1. Vadim A. Byvaltsev
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [VAB], [AAK], [EGB], [MAA], [BBS], [AVK], [YKD] and [VVS]. The first draft of the manuscript was written by [VAB], [AAK] and [KDR] and then all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Vadim A. Byvaltsev.

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Byvaltsev, V.A., Kalinin, A.A., Belykh, E.G. et al. Clinical and radiological outcomes of one-level cervical corpectomy with an expandable cage for three-column uncomplicated subaxial type «B» injures: a multicenter retrospective study. Eur Spine J 32, 1644–1654 (2023). https://doi.org/10.1007/s00586-023-07648-x

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