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Cages


KEY FACTS

Terminology

  • Cages used to reconstruct anterior spinal column after corpectomy

    • In vivo expansion of cage permits optimal fit and correction of deformity

Imaging

  • Cylindrical metallic prosthesis along craniocaudal span of vertebral body

  • Radiography & CT

    • Difficult to assess fusion

    • Assess stability of expandable cages (EC)

    • Determine EC-related complications

  • MR

    • Can be somewhat obscured by magnetic susceptibility artifact

    • Best to evaluate thecal sac and neural elements

Clinical Issues

  • Indications for corpectomy or vertebrectomy: Tumors, trauma, degenerative disease, infection, deformity

    • Cage provides immediate segmental stability, correction of sagittal plane deformity, & restoration of anterior vertebral support

  • Not designed as stand-alone device

    • Anterior instrumentation ± posterior instrumentation

  • Complications

    • Migration, subsidence, structural failure of cage

    • Extensive distraction for cage placement may end up causing radicular pain due to stretching of nociceptive fibers in joint capsule

Lateral radiograph displays an L2 burst fracture . Synex expandable cage extends from L1-L3 with bilateral L1 and L3 pedicle screws . The goals of surgery include decompressing neural elements, restoring vertebral body height, correcting angular deformity, and stabilizing columns of spine.

AP radiograph shows an expandable cage and lateral construct , which provides intervertebral distraction, ↑ anterior column height, and ↓ additional stress across pedicle screw constructs.

Lateral radiograph shows a nonexpandable cage across the C4 and C5 levels . ACDF is noted from C3-C5 . Titanium mesh cages have to be adjusted to the endplates and to the height of the defect. There is collapse of C5 vertebral body with subsidence of the anterior fusion plate and cage .

Sagittal CT shows cage spanning the C4-C5 levels . ACDF is noted from C3-C5 . There is collapse of the C5 endplate with subsidence of anterior plate/screw construct and cage . Kyphosis is present at C6-C7.

TERMINOLOGY

Synonyms

  • Expandable cage (EC), vertebral body (VB) replacement cage, VB prosthesis, distractible VB replacement

Definitions

  • Cages used to reconstruct anterior spinal column after corpectomy

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