A systematic review of the use of expandable cages in the cervical spine

Benjamin D. Elder, Sheng-fu Lo, Thomas A. Kosztowski, C. Rory Goodwin, Ioan A. Lina, John E. Locke, Timothy F Witham

Research output: Contribution to journalArticle

Abstract

Expandable vertebral body replacement cages (VBRs) have been widely used for reconstruction of the thoracolumbar spine following corpectomy. However, their use in the cervical spine is less common, and currently, no expandable cages on the market are cleared or approved by the US Food and Drug Administration for use in the cervical spine. The objective of this study was to perform a systematic review on the use of expandable cages in the treatment of cervical spine pathology with a focus on fusion rates, deformity correction, complications, and indications. A comprehensive Medline search was performed, and 24 applicable articles were identified and included in this review. The advantages of expandable cages include greater ease of implantation with less risk of damage to the end plate, less intraoperative manipulation of the device, and potentially greater control over lordosis. They may be particularly advantageous in cases with poor bone quality, such as patients with osteoporosis or metastatic tumors that have been radiated. However, there is a potential risk of overdistraction, which is increased in the cervical spine, their minimum height limits their use in cases with collapsed vertebra, and the amount of hardware in the expansion mechanism may limit the surface area available for fusion. The use of expandable VBRs are a valuable tool in the armamentarium for reconstruction of the anterior column of the cervical spine with an acceptable safety profile. Although expandable cervical cages are clearly beneficial in certain clinical situations, widespread use following all corpectomies is not justified due to their significantly greater cost compared to structural bone grafts or non-expandable VBRs, which can be utilized to achieve similar clinical outcomes.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalNeurosurgical Review
Volume39
Issue number1
DOIs
StatePublished - Jan 1 2016

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Spine
Bone and Bones
Lordosis
United States Food and Drug Administration
Osteoporosis
Pathology
Transplants
Safety
Costs and Cost Analysis
Equipment and Supplies
Neoplasms

Keywords

  • Biomechanics
  • Cervical corpectomy
  • Expandable cage
  • Supplemental fixation
  • Vertebral body replacement

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

A systematic review of the use of expandable cages in the cervical spine. / Elder, Benjamin D.; Lo, Sheng-fu; Kosztowski, Thomas A.; Goodwin, C. Rory; Lina, Ioan A.; Locke, John E.; Witham, Timothy F.

In: Neurosurgical Review, Vol. 39, No. 1, 01.01.2016, p. 1-11.

Research output: Contribution to journalArticle

Elder, Benjamin D. ; Lo, Sheng-fu ; Kosztowski, Thomas A. ; Goodwin, C. Rory ; Lina, Ioan A. ; Locke, John E. ; Witham, Timothy F. / A systematic review of the use of expandable cages in the cervical spine. In: Neurosurgical Review. 2016 ; Vol. 39, No. 1. pp. 1-11.
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