Expandable titanium interbody cage with adjustable height and lordosis for anterior cervical discectomy and fusion: a clinical and radiological study.
Academic Article
Overview
abstract
BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is a widely used approach for cervical pathologies. However, achieving optimal sagittal alignment with static implants remains challenging. Expandable titanium cages (ETC) may offer the advantage of precise alignment adjustments. This study presents our early clinical experience with ETC in ACDF. METHODS: Between 2019 and 2023, we performed a retrospective analysis at Weill Cornell Medicine, Department of Neurosurgery, New York-Presbyterian Hospital, examining patients who underwent ACDF with ETC. Hospital records, imaging, and pre- and post-operative visits were reviewed. We assessed clinical outcomes using the numeric rating scale (NRS) for arm and neck pain and the neck disability index (NDI). Radiological outcomes included cervical and segmental lordosis, disc height, cage subsidence, and fusion status. For data analysis, we used R Studio, with GraphPad Prism, for data visualization. RESULTS: Forty-four patients (mean age 53±13 years, 52.3% female) with 77 treated levels were analyzed. C5-6 (39%) was the most treated level, and 61.4% underwent two-level fusions. The median follow-up was 12 months (interquartile range, 11-13 months). Clinical outcomes showed significant improvement: NRS-Arm pain (2 to 0), NRS-Neck pain (6 to 2), and NDI (35 to 9). Radiographically, cervical lordosis improved from 4.4° to 9.0°, segmental lordosis from -0.9° to 2.4°, and anterior disc height from 4.0 to 8.5 mm, all sustained at follow-up. Fusion occurred in 69 of the 77 treated levels (fusion rate: 89.6%). Among 29 patients (65.9%) who completed approximately 12 months of follow-up (range, 11.6-41.2 months) with 53 treated levels, fusion occurred in 51 levels (fusion rate: 96.2%). Subsidence was observed in 16/77 segments (20.8%) overall, and in 10/53 segments (18.9%) within the subgroup with approximately 12-month follow-up. The overall rate of new subsidence decreased significantly over time. There were no revision surgeries or neurological complications. CONCLUSIONS: This study highlights the effectiveness and safety of ETC in achieving sagittal alignment and disc height restoration in ACDF.
