J Korean Neurosurg Soc.  2014 Mar;55(3):142-147. 10.3340/jkns.2014.55.3.142.

Comparison of Clinical and Radiologic Results between Expandable Cages and Titanium Mesh Cages for Thoracolumbar Burst Fracture

• Lee GJ
• Lee JK
• Hur H
• Jang JW
• Kim TS
• Kim SH

• KMID: 2191079
• DOI: http://doi.org/10.3340/jkns.2014.55.3.142

Abstract

OBJECTIVE
A thoracolumbar burst fracture is usually unstable and can cause neurological deficits and angular deformity. Patients with unstable thoracolumbar burst fracture usually need surgery for decompression of the spinal canal, correction of the angular deformity, and stabilization of the spinal column. We compared two struts, titanium mesh cages (TMCs) and expandable cages.
METHODS
33 patients, who underwent anterior thoracolumbar reconstruction using either TMCs (n=16) or expandable cages (n=17) between June 2000 and September 2011 were included in this study. Clinical outcome was measured by visual analogue scale (VAS), American Spinal Injury Association (ASIA) scale and Low Back Outcome Score (LBOS) for functional neurological evaluation. The Cobb angle, body height of the fractured vertebra, the operation time and amount of intra-operative bleeding were measured in both groups.
RESULTS
In the expandable cage group, operation time and amount of intraoperative blood loss were lower than that in the TMC group. The mean VAS scores and LBOS in both groups were improved, but no significant difference. Cobb angle was corrected higher than that in expandable cage group from postoperative to the last follow-up. The change in Cobb angles between preoperative, postoperative, and the last follow-up did not show any significant difference. There was no difference in the subsidence of anterior body height between both groups.
CONCLUSION
There was no significant difference in the change in Cobb angles with an inter-group comparison, the expandable cage group showed better results in loss of kyphosis correction, operation time, and amount of intraoperative blood loss.

Keyword

Thoracolumbar; Lumbar; Fracture; Corpectomy; Cage; Kyphosis

MeSH Terms

Body Height
Congenital Abnormalities
Decompression
Follow-Up Studies
Hemorrhage
Humans
Kyphosis
Spinal Canal
Spinal Injuries
Spine
Titanium*
Titanium

Figure

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  Fig. 1 Radiologic findings. Sagittal Cobb angle (CA) and vertebral body height.

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  Fig. 2 Case presentation 1. A : A 42-year-old woman sustained an L3 burst fracture after a fall. Lateral plain radiograph before the operation. B : Sagittal magnetic resonance imaging of the lumbar spine shows loss of height of the 3rd lumbar vertebra and bony retropulsion into the spinal canal. The Cobb angle was 7.71 degrees and anterior vertebral body height was 126.1 mm. C : With the use of a TMC, immediate post-operative lateral plain radiograph shows good implant placement with a Cobb angle of 10.21 degrees. D : One-year follow-up computed tomographic image shows solid fusion. E : On a lateral plain radiograph, -5.5 degrees of loss of kyphosis correction is observed.

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  Fig. 3 Case presentation 2. A : A 30-year-old man sustained an L3 burst fracture after a traffic accident. Lateral plain radiograph before the operation. B : Sagittal computed tomographic image of the lumbar spine showing vertebral height loss and bony retropulsion into the spinal canal. The Cobb angle was -6.19 degrees and anterior vertebral body height was 114.3 mm. C : With the use of an expandable cage, immediate post-operative lateral plain radiograph shows good implant placement with a Cobb angle of 12.71 degrees. D : One year follow-up computed tomographic image shows solid fusion. E : One year follow-up computed tomographic image shows solid fusion.

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  Fig. 4 The change in the Cobb angle between the TMC and expandable cage groups in the preoperative, postoperative and last follow-up periods. TMC : titanium mesh cage.

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