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Background: Most cervical fusion cages imperfectly mimic the anatomy of the intervertebral disc space. The production of individualized cages might be the next step to further improve spinal implants due to their enhanced load-bearing surface.Objective: To evaluate the planning, manufacturing, and implantation of an individualized cervical cage in co-operation with EIT and 3D Systems.Methods: A digital 3D model of the patient's cervical spine was rendered from the patients CT data. It was then possible to correct degenerative deformities by digitally repositioning the vertebrae and virtually resecting the osteophytes. The implantation of the cage can be simulated to check the accuracy of the fit. The cage is made of trabecular titanium and manufactured by Direct Metal Printing.Results: The pilot project for the implantation of the first individualized cervical cage ever, resulted in a highly accurate fit. During surgery, the cage self-located into the correct position after suspending distraction due to the implants unique end plate design. Furthermore, it was impossible to move the cage in any direction with the inserting instrument after suspending distraction for the same reason. Thus, it can be assumed that an individualized cervical implant provides excellent primary stability.Conclusion: Preconditions for the manufacturing of individualized cervical fusion cages using specific patient data are given. The implantation is uncomplicated. The improved load-bearing surface will lower the rate of implant dislocation and subsidence. The production of individualized cages at a reasonable price has to be evaluated by spine surgeons and the industry. [ABSTRACT FROM AUTHOR]

Purpose Illustrative cases are presented to demonstrate the surgical management of complex instability of the cervical spine. Methods Six patients with different underlying pathologies are presented along with their clinical and radiologic findings, surgical procedures, complications, and outcomes. Results Five patients underwent anteroposterior (AP) decompression and stabilization, of which two required secondary posterior stabilization because of dislocation or subsidence of the anterior osteosynthesis. In another case, a patient with a two-level corpectomy, a stable situation was achieved with an anterior approach only. The outcomes, measured according to Odom's criteria, were excellent in one patient, good in three patients, and fair in two patients. Conclusions In cases of complex cervical instability, combined AP decompression and stabilization minimizes the risk of anterior plate failure or dislocation of the vertebral body prosthesis. However, there may be increased risk of adjacent-level degeneration. Therefore, a combined procedure should be considered in selected patients. Not all patients with cervical instability require circumferential surgery. In two-level corpectomy cases, the decision between the less invasive anterior-only approach and the more stable combined approach can be difficult. However, in patients with proof of poor bone quality or with metabolic disorders, a more stable combined approach should be considered. [ABSTRACT FROM AUTHOR]

Background: The authors describe their experience with a modified version of the standard technique of open-door laminoplasty for the surgical treatment of spondylotic myelopathy in elderly patients with temporary removal of the laminae, extensive decompression, and pre-plating of the laminae beyond the surgical field. Methods: Description of surgical anatomy, surgical technique, indications, limitations, complications, and specific perioperative considerations, as well as specific information to give to the patient about surgery and potential risks. A summary of ten key points is given. Conclusions: Transection of the laminae on both sides (temporary laminectomy) and pre-plating of the laminae outside of the surgical field has several advantages: better decompression of the spinal canal and the neuroforamina on both sides, easier undercutting of adjacent vertebral arches for cranio-caudal decompression, and no risk of spinal cord injury by the screwdriver when attaching plates to the laminae. [ABSTRACT FROM AUTHOR]

Objective: To analyse the advantages and disadvantages of distractable titanium cages, polyether-etherketone cages, and iliac crest bone graft for the replacement of cervical vertebral bodies (VBR). Methods: The clinical and radiological results of 32 patients who underwent cervical corpectomy for the decompression of the spinal canal were retrospectively analysed and discussed. Results: For the vertebral body replacement the authors used distractable titanium cages ( n = 6), PEEK cages ( n = 19), and iliac crest bone graft ( n = 7). The neurological outcomes according to postoperative JOA scores did not show significant differences between the three groups. PEEK cages showed a high rate of secondary subsidence (32%). Discussion: Despite the risk of donor site morbidity the authors recommend iliac crest bone graft as primary choice for VBR because of its excellent fusion rate and its cost effectiveness. For revision cases we recommend titanium cages. [ABSTRACT FROM AUTHOR]