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Study Design.: A prospective nonrandomized controlled study. Objective.: To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMCs), nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cages, and three-dimensional–printed vertebral bodies (3d-VBs). Background.: Postoperative subsidence of TMCs in ACCF has been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) have been introduced to address this issue, but their outcomes remain controversial. Patients and Methods.: We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for a minimum of 2 years. Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index, and Visual Analog Scale scores, and radiographic outcomes, including function of spinal unit (FSU) height, fusion rate, and cervical alignment, were collected preoperatively and at each follow-up. A loss of FSU height ≥3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the least significance difference method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as sex, smoking status, implant subsidence, and pathology level were analyzed using the χ2 test.  Results.: Postoperative FSU height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07 ± 1.25mm, 2.11 ± 0.73mm, and 1.46 ± 0.71mm, respectively (P < 0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively (P = 0.031). All patients obtained solid fusion at a 2-year follow-up. We observed statistically significant differences in Visual Analog Scale and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the 3 groups. At a 2-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation.    Conclusion.: At a 2-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. Longer-term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB is necessary. Level of Evidence.: Level III—therapeutic. [ABSTRACT FROM AUTHOR]

Anterior cervical corpectomy and fusion achieves foraminal radicular and central medullary decompression and spinal stabilization in staged lesions. Many bone graft materials have been developed for the reconstruction of cervical lordosis and the restoration of intervertebral height after corpectomy. The PolyEtherKetoneEtherKetoneKetone (PEKEKK) is a semicrystalline thermoplastic polymer that can be reinforced with carbon fibers to create long and highly fenestrated rectangular cervical cages for corpectomy. This study aimed to evaluate the radiological outcomes of an innovative PEKEEKK cage compared with others grafting options. Forty-five consecutive patients who underwent surgery with PEKEKK cages between 2017 and 2019 at a spine institution, were matched with 15 patients with a titanium mesh cylindrical cage (TMC) and 15 patients with a tricortical structural iliac bone graft. The restoration of vertebral height and cervical lordosis postoperatively, and subsidence of the construct were evaluated. Complications were reported. The minimal follow-up was 5.1±2years. A better, but nonsignificant, postoperative gain in height was observed for PEKEKK (+8.1 ± 20%) and TMC cages (+8.2 ± 16%) than for iliac crest autograft reconstruction (+2.3 ± 15%, P = 0.119). The mean subsidence at the last follow-up was greater for TMC cages (-10.2 ± 13%), but was not significant, with -6.1 ± 10% for PEKEKK cages and -4.1 ± 7% for iliac crest autografts (P = 0.223). The gain in segmental cervical lordosis was significant (P < 0.001) and remained stable in all the groups. Although an improvement in radiologic anatomical parameters can be achieved with all cage groups, the PEKEKK cage can be considered as a safe alternative for reducing subsidence. [ABSTRACT FROM AUTHOR]

Propose: This meta-analysis aimed to determine whether 3D-printed artificial vertebral bodies (AVBs) have superior clinical efficacy compared to conventional titanium mesh cages (TMCs) for spinal reconstruction after total en bloc spondylectomy (TES) for spinal tumors. Methods: Electronic databases, including PubMed, OVID, ScienceDirect, Embase, CINAHL, Web of Science, Cochrane Library, WANFANG, and CNKI, were searched to identify clinical trials investigating 3D-printed AVB versus conventional TMC from inception to August 2023. Data on the operation time, intraoperative blood loss, preoperative and postoperative visual analogue scale (VAS) scores, preoperative and postoperative Frankel classification of spinal cord injury, vertebral body subsidence, and early complications were collected from eligible studies for a meta-analysis. Data were analyzed using Review Manager 5.4 and Stata 14.0. Results: Nine studies assessing 374 patients were included. The results revealed significant differences between the 3D-printed AVB and conventional TMC groups with regard to operation time (P = 0.04), intraoperative blood loss (P = 0.004), postoperative VAS score (P = 0.02), vertebral body subsidence (P < 0.0001), and early complications (P = 0.02). Conversely, the remaining preoperative VAS score and Frankel classifications (pre-and postoperative) did not differ significantly between the groups. Conclusion: The 3D-printed AVB in spinal reconstruction after TES for spinal tumors has the advantages of a short operative time, little intraoperative blood loss, weak postoperative pain, low occurrence of vertebral body subsidence and early complications, and a significant curative effect. This could provide a strong basis for physicians to make clinical decisions. [ABSTRACT FROM AUTHOR]

Abstract Background The nano-hydroxyapatite/polyamide-66 (n-HA/PA66) cage is a biomimetic cage with a lower elastic modulus than the titanium mesh cage (TMC). This study aimed to compare the long-term outcomes of the n-HA/PA66 cage and TMC in the anterior reconstruction of thoracic and lumbar fractures. Methods We retrospectively studied 113 patients with acute traumatic thoracic or lumbar burst fractures, comprising 60 patients treated with the TMC and 53 treated with the n-HA/PA66 cage for anterior reconstruction following single-level corpectomy. The radiographic data (cage subsidence, fusion status, segmental sagittal alignment) and clinical data (visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) for function) were evaluated preoperatively, postoperatively, and at final follow-up after a minimum 7-year period. Results The n-HA/PA66 and TMC groups had similar final fusion rates (96.2% vs. 95.0%). The cage subsidence at final follow-up was 2.3 ± 1.6 mm with subsidence of more than 3 mm occurring in 24.5% in the n-HA/PA66 group, which was significantly lower than the respective values of 3.9 ± 2.5 mm and 58.3% in the TMC group. The n-HA/PA66 group also had better correction of the bisegmental kyphotic angle than the TMC group (7.1° ± 7.5° vs 1.9° ± 8.6°, p

Objective: Previous studies have found satisfactory clinical results with the nano‐hydroxyapatite/polyamide 66 (n‐HA/PA66) cage to reconstruct the stability of anterior cervical column. However, studies evaluating the long‐term outcomes of the n‐HA/PA66 cage in multi‐level degenerative cervical myelopathy (MDCM) have not been reported. This study aims to compare the outcomes of corpectomy anterior cervical discectomy and fusion (ACDF) hybrid procedures between the n‐HA/PA66 cage and titanium mesh cage (TMC) to treat MDCM. Methods: After the screening for eligibility, this retrospective study involved 90 patients who underwent corpectomy ACDF hybrid (CACDFH) procedure from June 2013 to June 2018. The CACDFH procedure is the combination of ACDF and anterior cervical corpectomy and fusion (ACCF). According to the cage utilized, we categorized patients into a n‐HA/PA66 cage group and a TMC group. Then, stepwise propensity score matching (PSM) was performed to maintain comparable clinical data between groups. All the patients were followed up ≥4 years and the longest follow‐up time was 65.43 (±11.49) months. Cage subsidence, adjacent segment degeneration (ASD), segmental height (SH), segmental angle (SA), cervical lordosis (CL), and clinical data (visual analogue scale [VAS] and Japanese Orthopaedic Association [JOA] score) was evaluated preoperatively, at 1 week, and at the final surgery follow‐up. The independent student's t test and chi‐square test were applied to compare the differences between groups. Results: Through PSM analysis, 25 patients from the n‐HA/PA66 group were matched to 25 patients in the TMC group. The occurrence of ASD was 16.0% (4/25) in the n‐HA/PA 66 group, which was significantly less than in the TMC group at 44.0% (11/25) (p = 0.031). Moreover, the cage subsidence rate was significantly higher in the TMC group as compared to the n‐HA/PA 66 group (40.0% vs. 12.0%, p = 0.024). But there was no significant difference in SH, SA, and CL at any time after surgery as determined through follow‐up. The VAS and JOA scores significantly improved in both groups at 3 months postoperative and at final follow‐up. However, there were no significant differences in the VAS and JOA score at any time between the two groups in preoperative (p > 0.05). Conclusion: The n‐HA/PA66 cage is associated with lower rate of cage subsidence and ASD than the TMC in the treatment of MDCM. The n‐HA/PA66 cage could be superior to the TMC in corpectomy ACDF hybrid procedures. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to conduct a meta-analysis to compare the effectiveness and safety between titanium mesh cage (TMC) and nano-hydroxyapatite/polyamide 66 cage (n-HA/PA66) in the surgical treatment of cervical spondylotic myelopathy (CSM) through anterior cervical corpectomy and fusion (ACCF). MATERIALS AND METHODS: We implemented a comprehensive search strategy across multiple databases, including Wanfang, China Knowledge Network, China Biomedical Literature Database, Wipu, PubMed, Cochran, Embase, and Web of Science. To ensure a thorough examination of available literature, the databases were searched from their inception to January 2023. Two independent researchers evaluated the quality of the included studies by using established criteria. We used RevMan 5.4 (Review Manager Web, The Cochrane Collaboration, Copenhagen, Denmark) to facilitate data extraction and analysis. RESULTS: This analysis included seven controlled clinical studies. The meta-analysis results showed no statistically significant differences between the two groups in terms of operating time, intraoperative bleeding, preoperative Japanese Orthopedic Association (JOA) score, preoperative visual analog scale (VAS) score, preoperative and final follow-up C2-7 Cobb angles, and intervertebral fusion rate (p > 0.05). However, a significant difference was observed between the two groups in terms of the final follow-up JOA [MD = 0.77, 95% CI (0.58, 0.97), p < 0.00001], VAS [MD = -0.50, 95% CI (-0.71, -0.30), p < 0.00001], and sedimentation rate [RR = 0.30, 95% CI (0.18, 0.48), p < 0.00001]. CONCLUSIONS: The use of n-HA/PA66 in ACCF for treating CSM is safe and effective treatment with positive clinical efficacy. In addition, n-HA/PA66 has both effective clinical efficacy and significantly lower fusion settling rates compared to TMC. [ABSTRACT FROM AUTHOR]

Abstract Objective To analyse and compare the biomechanical differences between 3D-printed prostheses, titanium mesh cages and poorly matched titanium mesh cages in total en bloc spondylectomy (TES). Methods The finite element model of T10-L2 for healthy adults was modified to make three models after T12 total spondylectomy. These models were a 3D-printed prosthesis, titanium mesh cage and prosthesis-endplate mismatched titanium mesh cage for reconstruction. The range of motion (ROM), stress distribution of the endplate and internal fixation system of three models in flexion and extension, lateral bending and axial rotation were simulated and analysed by ABAQUS. Result In flexion, due to the support of the anterior prosthesis, the fixation system showed the maximum fixation strength. The fixation strength of the 3D-printed prosthesis model was 26.73 N·m /°, that of the TMC support model was 27.20 N·m /°, and that of the poorly matched TMC model was 24.16 N·m /°. In flexion, the L1 upper endplate stress of the poorly matched TMC model was 35.5% and 49.6% higher than that of the TMC and 3D-printed prosthesis, respectively. It was 17% and 28.1% higher in extension, 39.3% and 42.5% higher in lateral bending, and 82.9% and 91.2% higher in axial rotation, respectively. The lower endplate of T11 showed a similar trend, but the magnitude of the stress change was reduced. In the stress analysis of the 3D-printed prosthesis and TMC, it was found that the maximum stress was in flexion and axial rotation, followed by left and right bending, and the least stress was in extension. However, the mismatched TMC withstood the maximum von Mises stress of 418.7 MPa (almost twice as much as the buckling state) in rotation, 3 times and 5.83 times in extension, and 1.29 and 2.85 times in lateral bending, respectively. Conclusion Different prostheses with good endplate matching after total spondylectomy can obtain effective postoperative stable support, and the reduction in contact area caused by mismatch will affect the biomechanical properties and increase the probability of internal fixation failure.

Purpose: Long bone defects due to fractures resulting from high-energy trauma, infections and tumor resections are problems that orthopedic surgeons commonly face. We investigated the effects of a titanium mesh cage on bone healing with an induced membrane technique. Methods: Three groups, each composed of eight rabbits, were formed. Extraarticular diaphyseal bone defects were created. Femora of the first group were fixed with an empty titanium mesh cage and two K-wires. After formation of the defect, polymethylmethacrylate was inserted and fixed with a K-wire in the second group. At the third week, the cement was removed, a sterilized cancellous graft-filled titanium mesh cage was placed into the defect, and the membrane that was previously formed over the cement was placed on the cage and repaired. In the third group, sterilized cancellous grafts were filled into the titanium mesh cage, and the titanium mesh cage was fitted into the bone defect area. Results: At the end of the third month, all subjects were killed. Radiological data revealed that the healing of the bone in the second and third groups was significantly better than that in the first group. There was no difference between the second and third groups. A histological evaluation of the healing status, such as fibrous tissue, cartilage tissue and mature or immature bone formation, was performed. Histological healing in the second and third groups was also significantly better than that in the first group. Conclusion: We concluded that the combination of membrane-induced bone healing and graft-filled titanium mesh cages expedites osteogenesis in extraarticular bone defects. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical efficacy of 3D printed microporous titanium artificial vertebral body in the treatment of ossification of posterior longitudinal ligament (OPLL). Methods The clinical data of 64 patients with OPLL who underwent anterior subtotal vertebral resection and decompression followed by 3D printed microporous titanium artificial vertebral body or titanium mesh cage implantation and titanium plate internal fixation in our department from January of 2018 to January of 2020 were collected and retrospectively analyzed. Finally, only 57 cases meeting the inclusion and exclusion criteria were recruited. According to different implants, they were divided into observation group (n=28, of 3D printed microporous titanium artificial vertebral body) and control group (n=29, titanium mesh cage). The operation time, intraoperative blood loss, Japanese Orthopaedic Association (JOA) score and improvement rate, as well as incidence of prosthesis settlement and bone graft fusion were compared between the 2 groups. Results The operation time and intraoperative blood loss in the treatment group were 59.32±12.09 min and 102.75±11.25 mL respectively, while those in the control group was 67.55±4.71 min and 102.06±13.83 mL respectively. The operation time was significantly shorter in the observation group than the control group (P=0.001), but there was no statistical difference in intraoperative blood loss between them. During the follow-up time from 12 to 15 (14.3±2.7) months, 1 case (control group) complicated with wound infection, and 7 cases (3 cases in the treatment group and 4 cases in the control group) complicated with neck swallowing discomfort, which disappeared in 1~2 weeks later. All patients were bone healing at the last follow-up, and no fracture or malposition of implants were seen in all patients. At the last follow-up, the treatment group had a JOA score increased from 11.61±0.99 to 16.10±0.68, and an improvement rate of (83.03±12.68)%, and that in the control group was elevated from 11.37±1.08 to 16.03±0.56, and an improvement rate was (81.58±12.67)%. However, there was no significant difference in the improvement rate between the 2 groups. Significant difference was seen in prosthesis settlement between the treatment group (1 case, 3.57%) and the control group (12 cases, 41.38%, P=0.001). Conclusion 3D printed microporous titanium artificial vertebral body can reconstruct the stability of cervical spine, with the advantages of better bone material interface, faster installation, and less prosthesis sinking when compared with titanium mesh cage.

Abstract Background Pyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO. Methods Charts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle. Results All 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P

Abstract Study design This study was a retrospective review. Objective To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration.

Object: To investigate the stability and cost-effectiveness of the three-dimensional-printed (3DP) off-the-shelf (OTS) prosthesis in the reconstruction of the anterior column of the thoracic/lumbar spine after tumor resection. Methods: Thirty-five patients (26 with primary malignant tumors and nine with metastatic malignant tumors) who underwent tumor resection and anterior column reconstruction between January 2014 and January 2019 were included in a single institute. Patients were divided into the 3DP OTS prosthesis (3DP) group (n = 14) and the titanium mesh cage (TMC) group (n = 21) by the type of implant. The operation time, intraoperative blood loss, hospital stay, history of radiotherapy, surgical level and total cost were collected and compared between the two groups. Mechanical complications and radiological parameters including mean vertebral height, subsidence, fixation failure(nonunion, migration, screw loosening, rod breakage) rate were recorded at preoperation, 1 week, 3 months, 6 months, 12 months after surgery then at 1 year interval or stop until the end of survival. The follow-up patients were also sent with short form-36 to assess their health-related quality of life (HRQoL) and questions about the current condition of their disease. Results: The mean overall follow-up was 24.6 months. Of the 35 patients involved, six patients died and six were lost to follow-up. The differences between the two groups in operative time, intraoperative blood loss, and hospital stay were not statistically significant (p > 0.05). The differences in fixation failure and the subsidence rate between the two groups were not statistical significant (p > 0.05). The difference of subsidence rate between the cases with and without osteoporosis, cases with and without radiotherapy was statistically significant within each group (p < 0.05). However, the difference of subsidence rate between the surgical level above or below T10 was not statistically significant (p > 0.05). The response rate of the questionnaire among the survived patients was 100% (23/23 patients). The results of the Short Form- (SF-)36 between the two groups were similar (p > 0.05). The total cost was higher in the 3DP group (p < 0.05) with its higher graft cost (p < 0.05), but the differences in internal fixation cost and other cost were not statistically significant between groups (p > 0.05). Conclusion: Compared to TMC, the 3DP OTS prosthesis achieved similar clinical and radiological results in spinal anterior spinal column reconstruction of thoracic/lumbar spinal tumor resection. However, the 3DP OTS prosthesis was more expansive than TMC. [ABSTRACT FROM AUTHOR]

Objectives This retrospective study aimed to determine the impact of Modic changes (MCs) on cage subsidence (CS) and intervertebral fusion after anterior cervical corpectomy and fusion (ACCF). Methods This study enrolled 61 patients with MCs who underwent single-level ACCF between January 2010 and December 2015 at our institution. The control group included 63 age-matched patients without MCs treated during the same period. The results from clinical and radiological assessments were reviewed, and radiographic CS was defined by an intervertebral height at the final follow-up that was less than the postoperative intervertebral height. Results No significant differences in gender, age, operative time, blood loss, or follow-up results were observed between the MCs and control groups. Significantly more patients experienced CS in the MCs group than in the control group (41.0% vs. 15.9%; p = 0.003). The frequencies of CS among patients with type I MCs (40.0%, 8/20) and type II MCs (41.5%, 17/41) were significantly higher than that in the control group (15.9%, 10/63; p

ProposeThis meta-analysis aimed to determine whether 3D-printed artificial vertebral body have superior clinical and radiographic outcome than Titanium Mesh Cage(TMC) in single-level anterior cervical corpectomy and fusion.MethodsA comprehensive search of the PubMed, Embase, Cochrane Library, Web of Science, and CNKI (China National Knowledge Infrastructure) databases was conducted to find randomized control trials (RCTs) or cohort studies that compared 3D-printed artificial vertebral body with conventional Titanium Mesh Cage (TMC) in single-level anterior cervical corpectomy and fusion (SL-ACCF). Operation time; intraoperative blood loss; subsidence of vertebral body; preoperative, and final follow-up C2–C7 Cobb angle, Japanese Orthopedic Association (JOA) scores, and Visual Analog Scale(VAS) scores were collected from eligible studies for meta-analysis.ResultsWe included 6 cohort studies with 341 patients. The results of the meta-analysis showed that the 3D group has a shorter operation time than the traditional TMC group(p = 0.04) and the TMC group had more severe subsidence(≥3 mm) of vertebral body than the 3D group(p

Objective: To analyse and compare the biomechanical differences between 3D-printed prostheses, titanium mesh cages and poorly matched titanium mesh cages in total en bloc spondylectomy (TES).Methods: The finite element model of T10-L2 for healthy adults was modified to make three models after T12 total spondylectomy. These models were a 3D-printed prosthesis, titanium mesh cage and prosthesis-endplate mismatched titanium mesh cage for reconstruction. The range of motion (ROM), stress distribution of the endplate and internal fixation system of three models in flexion and extension, lateral bending and axial rotation were simulated and analysed by ABAQUS.Result: In flexion, due to the support of the anterior prosthesis, the fixation system showed the maximum fixation strength. The fixation strength of the 3D-printed prosthesis model was 26.73 N·m /°, that of the TMC support model was 27.20 N·m /°, and that of the poorly matched TMC model was 24.16 N·m /°. In flexion, the L1 upper endplate stress of the poorly matched TMC model was 35.5% and 49.6% higher than that of the TMC and 3D-printed prosthesis, respectively. It was 17% and 28.1% higher in extension, 39.3% and 42.5% higher in lateral bending, and 82.9% and 91.2% higher in axial rotation, respectively. The lower endplate of T11 showed a similar trend, but the magnitude of the stress change was reduced. In the stress analysis of the 3D-printed prosthesis and TMC, it was found that the maximum stress was in flexion and axial rotation, followed by left and right bending, and the least stress was in extension. However, the mismatched TMC withstood the maximum von Mises stress of 418.7 MPa (almost twice as much as the buckling state) in rotation, 3 times and 5.83 times in extension, and 1.29 and 2.85 times in lateral bending, respectively.Conclusion: Different prostheses with good endplate matching after total spondylectomy can obtain effective postoperative stable support, and the reduction in contact area caused by mismatch will affect the biomechanical properties and increase the probability of internal fixation failure. [ABSTRACT FROM AUTHOR]

Background: The standard recommended and common reconstruction method for spinal tuberculosis is titanium mesh bone graft and autogenous iliac crest. However, these methods have their own disadvantages.Objective: To evaluate the clinical efficacy of one-stage posterior debridement with iliac bone graft, titanium mesh bone graft, or nanohydroxyapatite/polyamide-66 cage in thoracic and lumbar tuberculosis.Materials and Methods: Between January 2013 and December 2018, 57 patients with thoracic or lumbar tuberculosis were treated by interbody bone graft combined with posterior internal fixation after debridement. Thirteen patients were treated with iliac bone graft to construct the stability of the vertebral body, 26 patients were treated with titanium mesh bone graft, and 18 patients were treated with nanohydroxyapatite/polyamide-66 cage bone graft. The main clinical results were evaluated by intervertebral height, cage subsidence, operation time, operative blood loss, postoperative hospitalization, postoperative complications, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, and bone graft fusion time. All the outcomes were recorded and analyzed by statistical methods.Results: The mean follow-up time was 24.5 months. Neurologic function was improved in most patients at the last follow-up. There were significant differences in ESR, CRP, and VAS score between preoperative and postoperative values; however, there were no significant differences in ESR, CRP, and VAS score among the three groups. There were no significant differences in operation time, blood loss, postoperative hospitalization, and postoperative complications among the three groups at discharge. There was no significant difference in ASIA grade among the three groups at the last follow-up. Nanohydroxyapatite/polyamide-66 cage group had a lower cage subsidence (P = 0.013). The bone graft fusion time of the nanohydroxyapatite/polyamide-66 cage group was significantly shorter than the iliac bone graft group and the titanium mesh bone graft (P < 0.05).Conclusions: The follow-up outcomes showed that the method involving one-stage posterior debridement and internal fixation, interbody graft, and fusion is an effective and safe surgical method for patients with thoracic and lumbar tuberculosis. The incidence rate of cage subsidence was less and the bone graft fusion time was shorter with nanohydroxyap atite/polyamide 66 cage when compared with iliac bone graft and titanium mesh bone graft in the surgical treatment of thoracic and lumbar tuberculosis. Nanohydroxyapatite/polyamide-66 cage has a promising application prospect to be a new bone graft material. [ABSTRACT FROM AUTHOR]

Background: Pyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO. Methods: Charts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle. Results: All 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P < 0.05). The local lordotic angle in group A was increased from preoperative − 1.7 ± 7.9° to postoperative 5.8 ± 7.1°, with angle loss of 1.5 ± 0.8° at the final follow-up, respectively (P < 0.05). The local lordotic angle in group B was increased from preoperative − 1.6 ± 7.8° to postoperative 13.5 ± 6.2°, with angle loss of 1.3 ± 0.8° at the final follow-up, respectively (P < 0.05). In the mean postoperative local lordotic angle, there was significant difference between the two groups at the time of immediate postoperative period or the final follow-up (P < 0.05). Conclusion: Posterior-only debridement, interbody graft using titanium mesh cage, posterior single-segment instrumentation and fusion represent a safe and effective treatment option for selected patients with mono-segmental lumbar and lumbosacral PVO. This approach may preserve more lumbar normal motor units with less blood loss and operation time when compared with that of short-segment fixation. But short-segment fixation was superior to the single-segment fixation in the correction of kyphosis. [ABSTRACT FROM AUTHOR]

Study design: This study was a retrospective review. Objective: To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods: This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results: A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion: Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration. [ABSTRACT FROM AUTHOR]

Introduction The problem of treating chronic unstable pelvic injuries is characterized by the complexity of delayed one-step or staged reduction, difficulties in choosing the technology and treatment options, complexity of selecting criteria for evaluating planning along with the effectiveness of treatment. The use of spinal systems to perform reduction manipulations and fixation of the pelvis is described in few clinical observations. Therefore, the assessment of the effectiveness of the sequential use of various fixation systems in one patient was regarded by the authors as a rare opportunity and determined the purpose of the study. Purpose Demonstration of the possibilities of various osteosynthesis methods and their combination in reconstructive surgery of the pelvis in a case of its severe chronic injury. Materials and methods We present a clinical case and a brief analysis of the literature. This is a case of a patient with posttraumatic pelvic deformity and imbalance syndrome as a leading component of pelvic ring deformity. The effectiveness of reconstruction options, including those with the use of spinal systems, was analyzed. The treatment was assessed with radiological study methods (X-ray and CT) with balance evaluation on a digital platform and functional scores for the quality of life. Results Correction of frontal deformity of the pelvis was achieved with compensation for a relative shortening of the left lower extremity, restoration of the center of rotation of the hip joints, and relief of pain in the lumbar region. The functional state according to the Majeed score system and clear radiological signs of stabilization of the pelvic ring while maintaining the position of the acetabulum in the frontal plane prove the effectiveness of hybrid osteosynthesis with the use of spinal fixation systems. Conclusion The leading syndromic complexes are instability with clinical manifestations of non-union and pain along with an imbalance syndrome, manifested by a gross deformation of the pelvic ring. Syndromic evaluation determines the tactics of surgical treatment while a detailed planning of the sequence of intervention, choice of the level of osteotomy, combination of osteosynthesis options using spinal fixation systems provide the solution of reconstructive pelvic surgery tasks in one session.

BackgroundAutogenous bone grafts, such as iliac bone or rib struts, have been used in the anterior reconstruction of spinal tuberculosis (STB) and have their own benefits and limitations. Here, we introduced a new method, the spinous process (SP), combined with a titanium mesh cage (TMC) as a bone graft in the stability reconstruction of lumbar or lumbosacral STBs. By retrospectively comparing patients who received SP+TMC to traditional TMC bone grafts or allogeneic bone grafts in terms of safety, efficacy and cost-effectiveness, we aimed to evaluate whether SP+TMC could be a possible alternative method.MethodsFrom 2010 to 2018, 69 patients who underwent one-stage posterior debridement with grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. Twelve patients who received SP combined with a TMC (SP+TMC, group A), 30 patients who received a TMC only (group B), and 27 patients who received allografts (group C) were included. Measurements including operative time, blood loss, length of hospital stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analyzed using SPSS 25.ResultsWe found that the SP+TMC group had fewer fixation segments, fewer pedicle screws implanted, a shorter operative time, reduced blood loss, and a considerably lower hospital cost than allografts. In addition, the TMC group had a comparable clinical outcome with the TMC group regarding lower economic cost.ConclusionOur study demonstrates that compared to a TMC or allograft, the use of SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to effective restoration of spinal stability. Furthermore, this approach is a cost-effective structural bone grafting method, especially for patients in developing countries.

This retrospective study aimed to determine the impact of Modic changes (MCs) on cage subsidence (CS) and intervertebral fusion after anterior cervical corpectomy and fusion (ACCF). This study enrolled 61 patients with MCs who underwent single-level ACCF between January 2010 and December 2015 at our institution. The control group included 63 age-matched patients without MCs treated during the same period. The results from clinical and radiological assessments were reviewed, and radiographic CS was defined by an intervertebral height at the final follow-up that was less than the postoperative intervertebral height. No significant differences in gender, age, operative time, blood loss, or follow-up results were observed between the MCs and control groups. Significantly more patients experienced CS in the MCs group than in the control group (41.0% vs. 15.9%; p = 0.003). The frequencies of CS among patients with type I MCs (40.0%, 8/20) and type II MCs (41.5%, 17/41) were significantly higher than that in the control group (15.9%, 10/63; p < 0.05). Both groups showed significant improvements in clinical assessment scores after surgery and at final follow-up compared with preoperative values (p < 0.05). In summary, all 61 patients with MCs who underwent ACCF achieved good fusion results. MCs in the surgical segment had no significant effect on intervertebral fusion, but both type 1 and type 2 MCs may increase the risk of CS. [ABSTRACT FROM AUTHOR]

Abstract Background To clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence. Methods The present retrospective cohort study included 73 consecutive patients who underwent single-level ACCF. Patients were divided into subsidence (n = 31) and non-subsidence groups (n = 42). Medical records and radiological parameters such as age, sex, operation level, segmental angle (SA), cervical sagittal angle (CSA), height of anterior (HAE) and posterior endplate (HPE), ratio of anterior (RAE) and posterior endplate (RPE), the alignment of TMC, the global cervical Hounsfield Units (HU) were analyzed. Clinical results were evaluated using the Japanese Orthopedic Association (JOA) scoring system and the Visual Analog Scale (VAS). Results Subsidence occurred in 31 of 73 (42.5%) patients. Comparison between the groups showed significant differences in the value of RAE, the alignment of TMC and the global cervical HU value (p 1.18 (OR = 6.116, 95%CI = 1.613–23.192, p = 0.008), alignment of TMC > 3° (OR = 5.355, 95%CI = 1.474–19.454, p = 0.011) and the global cervical HU value

Background: Posterolateral decompression and debridement in patients with TB spine led to defect in the anterior column which makes the spinal column unstable, thus making anterior column reconstruction an important step in surgical management.Objective: Through the study, authors sought to answer the following questions: 1) What are the differences in clinical outcomes between patients with TB spine undergoing anterior column reconstruction using titanium mesh cage versus PEEK cage? 2) What are the differences in radiological outcomes between these two groups of patients?Methods: This is a retrospective comparative study including patients with TB spine undergoing surgical management. The included subjects were divided into groups A and B depending on the implantation of PEEK or titanium mesh cage respectively for anterior column reconstruction. Outcome criteria analyzed included clinical criteria like VAS and ODI scores, radiological criteria like kyphosis correction, loss of kyphosis at follow-up, cage subsidence, and bony fusion on a 2D CT scan.Results: The study population included 14 patients in Group A and 15 patients in Group B. Improvement in VAS and ODI scores was comparable between groups. There was no significant difference in radiological outcome measures between the two groups, however, two patients from group B showed implant-related complications needing revision. All patients showed good bony fusion at the final follow-up.Conclusion: PEEK and titanium cages have comparable clinico-radiological outcomes for anterior column reconstruction in patients with active TB spine. Its advantages for being radiolucent and its ease of use may make it a choice of implant. [ABSTRACT FROM AUTHOR]

Abstract Background To compare the biomechanical properties of a novel height-adjustable nano-hydroxyapatite/polyamide-66 vertebral body (HAVB) with the titanium mesh cage (TMC) and artificial vertebral body (AVB), and evaluate its biomechanical efficacy in spinal stability reconstruction. Methods A 3D nonliner FE model of the intact L1-sacrum was established and validated. Three FE models which instrumented HAVB, TMC, and AVB were constructed for surgical simulation. A pure moment of 7.5 Nm and a 400-N preload were applied to the three FE models in 3D motion. The peak von Mises stress upon each prosthesis and the interfaced endplate was recorded for analysis. In addition, the overall and intersegmental range of motion (ROM) of each model was investigated to assess the efficacy of each model in spinal stability reconstruction. Results AVB had the greatest stress concentration compared with TMC and HAVB in all motions (25.6–101.8 times of HAVB, 0.8–8.1 times of TMC). The peak stress on HAVB was 3.1–10.3% of TMC and 1.6–3.9% of AVB. The maximum stress values on L2 caudal and L4 cranial endplates are different between the three FE models: 0.9–1.9, 1.3–12.1, and 31.3–117.9 times of the intact model on L2 caudal endplates and 0.9–3.5, 7.2–31.5, and 10.3–56.4 times of the intact model on L4 cranial endplates in HAVB, TMC, and AVB, respectively, while the overall and segmental ROM reduction was similar between the three models, with AVB providing a relatively higher ROM reduction in all loading conditions (88.1–84.7% of intact model for overall ROM and 69.5–82.1% for L1/2, 87.0–91.7% for L2/4, and 71.1–87.2% for L4/5, respectively). Conclusions HAVB had similar biomechanical efficacy in spinal stability reconstruction as compared with TMC and AVB. The material used and the anatomic design of HAVB can help avoid stress concentration and the stress shielding effect, thus greatly reducing the implant-associated complications. HAVB exhibited some advantageous biomechanical properties over TMC and AVB and may prove to be a potentially viable option for spinal stability reconstruction. Further in vivo and vitro studies are still required to validate our findings and conclusions.

Study design: Prospective case series. Purpose: To describe a new technique for anterior column reconstruction after kyphectomy in myelomeningocele patients using titanium mesh cage and to evaluate outcomes and complications. Methods: Sixteen patients with severe dorsolumbar kyphosis 2ry to myelomeningocele were enrolled with a mean age of 10.1 years. Kyphectomy procedure and long spinopelvic fixation were done, titanium mesh cage was used to reconstruct the anterior column. Operative time and intraoperative blood loss were calculated. Using the Cobb method, pre and postoperative measurements of local/regional kyphosis were done. Degree and mean percentage of correction were calculated. Anterior intervertebral height of the kyphotic area was also measured. The mean follow-up period was 27 months. Results: Operative time was 271.3 min ± 25, and estimated intraoperative blood loss was 781.3 mL ± 92.3. On average, 2.5 vertebrae were resected. All 16 patients were able to lie supine immediately postoperatively. The mean preoperative local/regional kyphosis was 107.5°, and 106.9° respectively, corrected to 22.5° and 28.8° postoperatively, with a mean degree of correction of 85° and 78.1° respectively. Mean preoperative anterior intervertebral height was 3.54 cm, improved to 4.64 cm postoperatively. Only 2 cases had a superficial wound infection managed conservatively. At the latest follow-up, no loss of correction pseudoarthrosis occurred, and all patients showed solid fusion. Conclusion: Titanium mesh cage is an efficient, easy method for anterior reconstruction following kyphectomy in myelomeningocele patients, to maintain postoperative correction. Level of evidence: Therapeutic studies, Level IV study

Background Data: Burst fractures are commonly provoked by axial compression which disrupts the anterior column. In this setting, posterior stabilization using pedicle screws alone may lead to delayed kyphosis and instrumentation failure due to inadequate support of the anterior column. Purpose: To evaluate the efficacy of pedicle screw instrumentation combined with transpedicular titanium mesh cage augmentation for treatment of burst fractures. Study Design: Prospective descriptive cohort clinical case study. Patients and Methods: Fourteen neurologically intact patients with acute incomplete thoracolumbar burst fracture (AO type A 3.1), and operated upon through period from January 2016 to June 2017 were included. Patients were treated using a three vertebrae pedicle screw fixation construct combined with bilateral transpedicular titanium mesh cage augmentation of the fracture. Patients were followed for at least one year. Data about pain (VAS), function (ODI) and vertebral body deformity (Beck index and local kyphotic angle) were recorded prospectively. Results: Patients were operated within 5 days after trauma. The mean VAS score improved after surgeryfrom 8.2±1.3 to 3.7±1.1 postoperatively and to 1.8±0.7 at final follow up(P˂0.05). The mean ODI score improved from 69.4±5.2 preoperatively to 17.2±2.4 at final follow up. The mean Beck index improved from 0.63 preoperatively to 0.81 postoperatively and to 0.79 at final follow up. The mean local kyphotic angle improved from 20.4opreoperatively to 11.5opostoperatively and declined to 13.7o at final visit. No patient had neurological deterioration or hardware failure during the follow up.The mean follow up was 13.4±1.8 months. Conclusion: Posterior stabilization using pedicle screw fixation in combination with titanium mesh cage augmentation can maintain vertebral restoration, prevent hardware failure and lead to better clinical outcome. (2018ESJ162)

The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32–56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26–53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery. PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients. Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability. [ABSTRACT FROM AUTHOR]

Background: To clarify the risk factors for subsidence of titanium mesh cage (TMC) following single-level anterior cervical corpectomy and fusion (ACCF) to reduce subsidence.Methods: The present retrospective cohort study included 73 consecutive patients who underwent single-level ACCF. Patients were divided into subsidence (n = 31) and non-subsidence groups (n = 42). Medical records and radiological parameters such as age, sex, operation level, segmental angle (SA), cervical sagittal angle (CSA), height of anterior (HAE) and posterior endplate (HPE), ratio of anterior (RAE) and posterior endplate (RPE), the alignment of TMC, the global cervical Hounsfield Units (HU) were analyzed. Clinical results were evaluated using the Japanese Orthopedic Association (JOA) scoring system and the Visual Analog Scale (VAS).Results: Subsidence occurred in 31 of 73 (42.5%) patients. Comparison between the groups showed significant differences in the value of RAE, the alignment of TMC and the global cervical HU value (p < 0.001, p = 0.002, p < 0.001). In multivariate logistic regression analysis, RAE > 1.18 (OR = 6.116, 95%CI = 1.613-23.192, p = 0.008), alignment of TMC > 3° (OR = 5.355, 95%CI = 1.474-19.454, p = 0.011) and the global cervical HU value< 333 (OR = 11.238, 95%CI = 2.844-44.413, p = 0.001) were independently associated with subsidence. Linear regression analysis revealed that RAE is significantly positive related to the extent of subsidence (r = - 0.502, p = 0.006).Conclusion: Our findings suggest that the value of RAE more than 1.18, alignment of TMC and poor bone mineral density are the risk factors for subsidence. TMC subsidence does not negatively affect the clinical outcomes after operation. Avoiding over expansion of intervertebral height, optimizing placing of TMC and initiation of anti-osteoporosis treatments 6 months prior to surgery might help surgeons to reduce subsidence after ACCF. [ABSTRACT FROM AUTHOR]

Background: To compare the biomechanical properties of a novel height-adjustable nano-hydroxyapatite/polyamide-66 vertebral body (HAVB) with the titanium mesh cage (TMC) and artificial vertebral body (AVB), and evaluate its biomechanical efficacy in spinal stability reconstruction. Methods: A 3D nonliner FE model of the intact L1-sacrum was established and validated. Three FE models which instrumented HAVB, TMC, and AVB were constructed for surgical simulation. A pure moment of 7.5 Nm and a 400-N preload were applied to the three FE models in 3D motion. The peak von Mises stress upon each prosthesis and the interfaced endplate was recorded for analysis. In addition, the overall and intersegmental range of motion (ROM) of each model was investigated to assess the efficacy of each model in spinal stability reconstruction. Results: AVB had the greatest stress concentration compared with TMC and HAVB in all motions (25.6–101.8 times of HAVB, 0.8–8.1 times of TMC). The peak stress on HAVB was 3.1–10.3% of TMC and 1.6–3.9% of AVB. The maximum stress values on L2 caudal and L4 cranial endplates are different between the three FE models: 0.9–1.9, 1.3–12.1, and 31.3–117.9 times of the intact model on L2 caudal endplates and 0.9–3.5, 7.2–31.5, and 10.3–56.4 times of the intact model on L4 cranial endplates in HAVB, TMC, and AVB, respectively, while the overall and segmental ROM reduction was similar between the three models, with AVB providing a relatively higher ROM reduction in all loading conditions (88.1–84.7% of intact model for overall ROM and 69.5–82.1% for L1/2, 87.0–91.7% for L2/4, and 71.1–87.2% for L4/5, respectively). Conclusions: HAVB had similar biomechanical efficacy in spinal stability reconstruction as compared with TMC and AVB. The material used and the anatomic design of HAVB can help avoid stress concentration and the stress shielding effect, thus greatly reducing the implant-associated complications. HAVB exhibited some advantageous biomechanical properties over TMC and AVB and may prove to be a potentially viable option for spinal stability reconstruction. Further in vivo and vitro studies are still required to validate our findings and conclusions. [ABSTRACT FROM AUTHOR]

To investigate the effectiveness of allograft bones combined with poly-ether-ether-ketone (PEEK) cages or titanium mesh cages (TMCs) in the management of cervical spinal tuberculosis. A total of 16 patients with cervical spinal tuberculosis who underwent anterior debridement, reconstruction with allograft bones combined with PEEK cages or TMCs, and anterior plate fixation between 2013 and 2016 were retrospectively studied. Neck pain, neurologic status, operating time, intraoperative blood loss, cervical spine alignment, bony fusion, and self-reported clinical outcomes were reviewed. Six patients underwent 1 level reconstruction using PEEK cages and 10 patients received TMCs reconstruction. Patients received a mean follow-up time of 45.9 ± 13.1 months. Neck pain was greatly relieved, as visual analog scale scores decreased from 4.6 ± 1.3 preoperatively to 0.7 ± 0.5 at the final follow-up (P < 0.05). Neurologic status was improved in all patients with neurologic deficits, with 9 patients improving by 1 grade and 1 patient by 2 grades. Kyphosis angle was corrected from 1.3 ± 12.0 degrees preoperatively to –5.4 ± 10.2 degrees postoperatively (P < 0.05) and remained at –3.6 ± 9.6 degrees at the final follow-up (P < 0.05). Bony fusion was achieved in all patients, with a mean time to the fusion of 3.8 ± 1.3 months. There was no implant failure or signs of cervical spinal tuberculosis recurrence. Excellent results, good results, and fair results were reported in 37.5%, 56.25%, and 6.25% of patients, respectively. Allograft bone combined with PEEK cages and TMCs could bring about favorable clinical results in patients with cervical spinal tuberculosis. This method could be an alternative to autologous bone grafting method in the management of certain cases. [ABSTRACT FROM AUTHOR]

We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of anterior fusion option on the short- and long-time outcomes on multilevel spinal reconstructions in young children.Methods: Forty-five patients aged under 4 years old (2 years 2 months ± 11 months in average) underwent spinal reconstruction due to tuberculosis spondylitis (35), pyogenic spondylitis (9) and spinal tumors (1) complicated by angular kyphosis exceeded 20° (49.2° ± 14.3° in average). All lesions involved two or more spinal motion segments. Clinical and radiographic data were compared in two groups depended on the types of anterior fusion: titanium mesh cage with bone graft (TMC + BG) (19 patients) and cortical BG only (26). The average follow-up was 5 years 10 months ± 2 years 8 months (min = 3 years; max = 12 years).Results: The deformity correction was similar in groups. The operation time and blood loss were less in TMC + BG group (p = 0.001) as a times for anterior bone block formation (p < 0.001) and posterior instrumentation removal (p = 0.003). Ten late post-op complications registered include disease's recurrence (1), pseudoarthrosis (6), deformity progression (1) and graft resorption (1). The complication rate was less in TMC + BG than in BG group: two and eight cases consequently, p = 0.024.Conclusions: Multilevel spinal reconstruction in early aged patients is safe and effective procedure. The anterior fusion by TMC with bone autograft has advantages of reducing blood loss, operation time, time for anterior block formation and complications rate compared with bone autograft only. These slides can be retrieved under Electronic Supplementary Material. [ABSTRACT FROM AUTHOR]

MINI: Posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion may be a reliable procedure for selected patients with scoliokyphosis due to a hemivertebra, providing good correction both on the coronal and sagittal planes, saving mobile segments with lower risk of implants failures.Study Design: Perspective study.Objectives: To evaluate indications and preliminary results of posterior hemivertebra resection with anterior structural reconstruction with titanium mesh cage and short segmental fusion.Summary Of Background Data: There exist a lot of reports on posterior hemivertebra resection for the early surgical intervention of congenital scoliosis because of hemivertebra. However, a few reports describe the procedure of the anterior structural reconstruction after posterior hemivertebra resection.Methods: In this study, 18 selected children of mean age 5.4 years (range, 2-12 yrs) with scoliokyphosis because of hemivertebra were treated with posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion. They were followed for an average of 37.1 (24-85) months. Radiograghs, operative reports, and patient charts were studied to evaluate the correction and complications.Results: Average fused segments were 1.67 (1-3). The segmental scoliosis was 40.1° before surgery, 4.1° postsurgery, and 5.7° at the latest the follow up. Moreover, the segmental kyphosis (difference to normal segmental alignment) was improved from 27.6° to 3.9°. The correction of the compensatory cranial and caudal curve was 74.7% and 82.4%. The trunk shift improved from 17.7 mm to 5.3 mm. No complications occurred until the latest follow up.Conclusion: Posterior hemivertebra resection with anterior structural reconstruction and short segmental fusion is a reliable procedure for selected patients with scoliokyphosis because of hemivertebra. A structural reconstruction is essential to the avoidance of overcorrection of the segmental scoliosis and resultant postoperative coronal imbalance with limited fused levels in some patients, increasing chances of short segmental fusion and saving mobile segments. As a fulcrum, anterior reconstruction with a titanium mesh cage could help to improve the correction of segmental kyphosis. Furthermore, the cage may help to stabilize the level of hemivertebra resection like a structural autograft, enhancing the postoperative stability and decreasing the stress of the pedicle and implants.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

It has been reported that anterior cervical decompression has good clinical outcomes for the treatment of adjacent three-level cervical spondylotic myelopathy (CSM). However, the application of a long plate in the anterior cervical spine poses substantial risks of soft tissue damage. In this retrospective study, we aimed to analyze the clinical and radiological results of the hybrid construction with titanium mesh cage (TMC) plus plate and self-locking stand-alone cage for treatment of adjacent three-level CSM. A total of 28 consecutive patients with adjacent three-level CSM were treated by anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage. Clinical outcomes, complications, fusion rate and time, cage subsidence and spinal curvature were assessed. The mean follow-up period was 22.8 months. The average operative time was 103 ± 18.5 min, and the average blood loss was 115 ± 13.3 mL. The JOA score and degree of spinal curvature were significantly increased at the final follow-up compared with preoperatively ( P < 0.05). Twenty-seven cases finally achieved a solid fusion, and the average time to achieve a solid fusion was 6.2 months. Postoperative complications included one case of cerebrospinal fluid leakage (3.57%), one case of temporary sore throat (3.57%) and two cases of TMC subsidence (7.1%). No dysphagia and hoarseness were observed. Anterior decompression and hybrid reconstruction with TMC plus plate and self-locking stand-alone cage could be used safely and effectively for the treatment of adjacent three-level CSM. It could effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes. [ABSTRACT FROM AUTHOR]

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Repair of large segmental defects of long bones are a tremendous challenge that calls for a novel approach to supporting immediate weight bearing and bone regeneration. This study investigated the functional and biological characteristics of a combination of a tailor-made titanium mesh cage with a plate (tTMCP) with tetrapod-shaped alpha tricalcium phosphate granules (TB) and basic fibroblast growth factor (bFGF)-binding ion complex gel (f-IC gel) to repair 20-mm segmental radial defects in dogs. The defects were created surgically in 18 adult beagle dogs and treated by implantation of tTMCPs with TB with (TB-gel group) or without (TB group) f-IC gel. Each tTMCP fitted the defect well, and all dogs could bear weight on the affected limb immediately after surgery. Dogs were euthanized 4, 8 and 24 weeks after implantation. Histomorphometry showed greater infiltration of new vessels and higher bone union rate in the TB-gel group than in the TB group. The lamellar bone volume and mineral apposition rate did not differ significantly between the groups, indicating that neovascularization may be the primary effect of f-IC gel on bone regeneration. This combination method which is tTMCP combined with TB and f-IC gel, would be useful for the treatment of segmental long bone defects. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy and safety of a new type of titanium mesh cage (NTMC) in hybrid anterior decompression and fusion method (HDF) in treating continuously three-level cervical spondylotic myelopathy (TCSM).Methods: Ninety-four cases who had TCSM and accepted the HDF from Jan 2007 to Jan 2010 were included. Clinical and radiological outcomes were compared between cases who had the NTMC (Group A, n = 45) and traditional titanium mesh cage (TTMC, Group B, n = 49) after corpectomies. Each case accepted one polyetheretherketone cage (PEEK) after discectomy.Results: Mean follow-up were 74.4 and 77.3 months in Group A and B, respectively (p > 0.05). Differences in cervical lordosis (CL), segmental lordosis (SL), anterior segmental height (ASH) and posterior segmental height (PSH) between two groups were not significant preoperatively, 3-days postoperatively or at final visit. However, losses of the CL, SL, ASH and PSH were all significantly larger in Group B at the final visit, so did incidences of segmental subsidence and severe subsidence. Difference in preoperative Japanese Orthopedic Association (JOA), visual analog scale (VAS), neck disability index (NDI) or SF-36 between two groups was not significant. At the final visit, fusion rate, JOA, and SF-36 were all comparable between two groups, but the VAS and NDI were both significantly greater in Group B.Conclusions: For cases with TCSM, HDF with the NTMC and TTMC can provide comparable radiological and clinical improvements. But application of the NTMC in HDF is of advantages in decreasing the subsidence incidence, losses of lordosis correction, VAS and NDI. [ABSTRACT FROM AUTHOR]

Background: Tuberculous spondylitis being endemic in developing countries including Pakistan has considerable socio-economic and orthopaedic concern. In spite of all the advances regarding diagnosis, treatment and total control of many diseases, this slow but grave disease still affects considerable number of cases and makes them disabled and even paralyzed. The objective of the study was to determine the neurological outcome in terms of Frankel Scale after anterior decompression and stabilization with titanium mesh cage in thoracolumbar caries spine. Methodology: The case series (descriptive) study was conducted in Orthopaedic ward of Ghurki Trust Teaching Hospital/Lahore Medical & Dental College, Lahore from 1st Jan. 2015 to 31st Dec. to 2015. In this randomized controlled trial of 150 patients who were admitt ed either through OPD or through emergency. Data was collected by using non-probability consective sampling technique. Patient was prepared for surgery. A locally made fixed interbody Titanium Mesh Cage, with packed bone graft, was placed. A Boston brace was applied for at least 6 months to provide external support to spine. The neurological outcome was assessed in terms of Frankel Scale post-operatively at the end of one month, 6 months and 12 months. Results: In our study, out of 150 cases, 42% (n=63) were between 15-30 years of age while 58% (n=87) were between 31-60 years of age, mean+sd was calculated as 32.85±8.35 years, 45.33% (n=68) were male and 54.67% (n=82) were females. Frequency of neurological outcome regarding improvement was recorded as 52% (n=78). Conclusion: We concluded that the neurological outcome in terms of Frankel Scale after anterior decompression and stabilization with titanium mesh cage in thoracolumbar caries spine is good and this technique may be used in future in our population. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of hematogenous pyogenic spondylitis and spondylodiskitis includes anterior debridement, stabilization, and fusion. Titanium mesh cage (TMC) has been advocated to immediately correct deformity and eradicate infection with low recurrence rates. There are no comprehensive reviews on TMC. Purpose: To evaluate recorded information regarding surgical outcome with the use of TMC for treating patients with pyogenic spinal infection. Study design: Comprehensive review. Methods: The terms 'titanium cage', 'spine', 'infection' were searched. A total of 486 peer-reviewed papers published from 2002 to 2012 were obtained from PubMed search. Fifteen Level IV articles with 363 patients were enrolled for consideration. Finally, 192 (53 %) patients who received TMC were eligible and included in this review. Age, comorbidities, indications for surgery, abscess formation, time lapsed between symptoms initiation and surgery, microbiology, radiological spine restoration, neurological outcome, and complications following surgery are evaluated. Results: The average age at the index surgery was 57 years, range 15-85 years. The reported time lapsed from symptoms presentation to diagnosis varied significantly from 1 week to 2 years. On admission, there reported paravertebral and/or epidural abscess in 48 % and neurological impairment in 51 % of the patients. One hundred and seventy-seven comorbidities were recorded in 192 patients. Bone biopsy and culture revealed gram (+) bacteria in 71 %, gram (−) in 24 %, and multiple bacteria in 1 %, while it was negative in 3.1 % of the patients. TMC was most commonly (49 %) implanted in the lumbar spine. The follow-up observation following surgery averaged 26 months, range 10-116 months. Most of the studies reported decrease in segmental kyphosis and neurological improvement in incomplete lesions postoperatively. TMC was primarily revised for early dislodgment or cage misplacement in 3.2 % of the patients. Infection recurrence was recorded in two patients (1.3 %), but revision surgery needed in one (0.65 %) patient. Mortality was reported in 5.8 % of the patients. Conclusions: TMC offers an advantageous and safe technique for spinal debridement and fusion for hematogenous spinal infection. TMC safeguarded medium-term spinal stability with low infection recurrence rates, which were independent form causative pathogen, age, and comorbidities. [ABSTRACT FROM AUTHOR]

Study Design: A case series.Objective: The aim of this study was to evaluate the clinical outcomes of patients with osteomyelitis of the cervical spine who were treated with single-stage anterior debridement and fusion using titanium mesh cages along with anterior plates.Summary Of Background Data: There have been few studies in single-stage surgical treatment of osteomyelitis of the cervical spine using titanium mesh cages along with anterior plates.Methods: Twenty-four patients treated for osteomyelitis of the cervical spine are presented. There were 11 male and 13 female with an average age of 53.3 years (42-63). Seventeen patients presented with a neurologic deficit at the time of diagnosis. Surgical treatment consisted of anterior debridement and fusion using titanium mesh cages along with anterior plates as a one-step procedure. The patients' records and radiographs were retrospectively analyzed and follow-up clinical and radiographic data obtained.Results: The median follow-up period was 52 months. There were no implant failures. All patients showed a solid bony fusion without any recurrence of infection at latest follow-up. Changes in pain level, hematologic parameters, and neurologic status demonstrated a significant clinical improvement in all patients.Conclusion: This single-stage surgical treatment for osteomyelitis of the cervical spine provided satisfactory results. There is no increased risk of recurrence or persistence of infection related to the implantation of titanium mesh cages and instrumentation.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Background Atlantoaxial fusion is a surgical technique that is performed for the treatment of atlantoaxial instability. The standard surgical procedure is fixation of the atlantoaxial complex via a C1 lateral mass and C2 pedicle screw with posterior wiring. Bone grafting material may still be biomechanically suboptimal, such as autologous bone obtained from osteoporotic patients, and may result in collapse and loosening of posterior wiring. Methods Fourteen patients with C1 lateral mass and C2 pedicle fixation as a result of atlantoaxial instability were included in this study. All patients were treated by a single surgeon using a titanium mesh cage with demineralized bone matrix packing. Patient clinical history, imaging data, and medical records were reviewed. To evaluate bony fusion, measurement of the atlantodental interval and computed tomography were performed in the preoperative period, immediate postoperative period, and at 1, 3, 6, and 12 months postoperatively. The Wilcoxon signed-rank test was used to compare differences in the radiologic evaluation at 1 and 12 months postoperatively. Results Bone fusion was achieved in all patients (100%). Of the 14 patients, 11 had rheumatoid arthritis and 3 had trauma. The mean atlantodental interval of patients with rheumatoid arthritis was 1.85 mm in the immediate postoperative period, 1.96 mm at 1 month postoperatively, 1.98 mm at 3 months postoperatively, 1.96 mm at 6 months, and 1.93 mm at 12 months. Hardware failure and other complications were not observed. Conclusions The titanium mesh cage has several advantages compared with bone autografts, including reduced donor-site morbidity, immediate rigid fixation, and successful bone fusion. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether 3D-printed artificial vertebral body can reduce prosthesis subsidence rate for patients with cervical chordomas, through comparing the rates of prosthesis subsidence between 3D printing artificial vertebral body and titanium mesh for anterior spinal reconstruction after total spondylectomy., Methods: This was a retrospective analysis of patients who underwent surgical treatment for cervical chordoma at our hospital from March 2005 to September 2019. There were nine patients in the group of 3D artificial vertebral body (3D group), and 15 patients in the group of titanium mesh cage (Mesh group). The patients' characteristics and treatment data were extracted from the medical records, including age, gender, CT hounsfield unit of cervical vertebra and surgical information, such as the surgical segments, time and blood loss of surgery, frequency and degree of prosthesis subsidence after surgery. Radiographic observations of prosthesis subsidence during the follow-up, including X-rays, CT, and magnetic resonance imaging were also collected. SPSS 22.0 was used to analysis the data., Results: There was no significant difference between the two groups in gender, age, CT hounsfield unit, surgical segments, time of surgery, blood loss of posterior surgery and total blood loss. Blood loss of anterior surgery was 700 (300, 825) mL in 3D group and 1 500 (750, 2 800) mL in Mesh group ( P < 0.05). The prosthesis subsidence during the follow-up, 3 months after surgery, there was significant difference between the two groups in mild prosthesis subsidence ( P < 0.05). The vertebral height of the 3D group decreased less than 1 mm in eight cases (no prosthesis subsidence) and more than 1 mm in one case (mild prosthesis subsidence). The vertebral height of the Mesh group decreased less than 1 mm in five cases (no prosthesis subsidence), and more than 1 mm in eight cases (mild prosthesis subsidence). Two patients did not have X-rays in 3 months after surgery. There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 12 months ( P < 0.01). The vertebral height of eight cases in the 3D group decreased less than 1 mm (no prosthesis subsidence) and one case more than 3 mm (severe prosthesis subsidence). Four of the 15 cases in the Mesh group decreased less than 1 mm (no prosthesis subsidence), two cases more than 1 mm (mild prosthesis subsidence), and nine cases more than 3 mm (severe prosthesis subsidence). There was a statistically significant difference between the two groups in the prosthesis subsidence rate at the end of 24 months ( P < 0.01). The vertebral height of seven cases in the 3D group decreased less than 1 mm (no prosthesis subsidence), one case more than 3 mm (severe prosthesis subsidence), and one case died with tumor. One case in the Mesh group decreased less than 1 mm (no prosthesis subsidence), one case more than 1 mm (mild prosthesis subsidence), 11 case more than 3 mm (severe prosthesis subsidence), one case died with tumor and one lost the follow-up. Moreover, at the end of 12 months and 24 months, there was significant difference between the two groups in severe prosthesis subsidence rate ( P < 0.01)., Conclusion: 3D-printed artificial vertebral body for anterior spinal reconstruction after total spondylectomy for patients with cervical chordoma can provide reliable spinal stability, and reduce the incidence of prosthesis subsidence after 2-year follow-up.