Loose Screws Rattle Patients' Neck CagesWhen the discs in the spine start to wear out, treatment may be needed. This is also true for the neck (cervical spine). Removing the front portion of a spinal vertebra (the vertebral body) is called corpectomy. Two or three vertebral bodies are typically removed in a corpectomy procedure.
Doctors may insert a section of bone graft into the space where the vertebral bodies were taken out. They may also use metal plates to hold the spine together so the bone graft will heal (fuse) in place.
A new method was devised in the mid-1990s. Square, mesh cages made of titanium can be inserted to replace the bones. The cages are packed with bone graft to make them rigid. Locking plates hold the cages in place. One method is to use mesh cages made of titanium. These titanium cages are often used at one or more levels in the neck.
There are some problems that can happen with this approach. Doctors at Tulane University studied 21 cases of corpectomy with cages over a five-year period. They found that one-third of all patients had some problems after the surgery.
No deaths occurred, but in some patients, the cages moved or the screws loosened. Sometimes, the plates would stick out too far. Other troubles involved single events that only affected one person. The patients with more than two bones removed seemed to have more problems--but only removing half of a bone caused the most trouble.
The authors feel that a 33 percent complication rate with titanium cages is high but not surprising. Removing a section of bone, inserting cages, and attempting to hold them in place is a major undertaking. Add to this neck movement, muscle loading, and fatigue, each of which add forces to the weakened area. Doctors are looking for better ways to perform this surgery. Titanium cages may only be a middle step before something better is found.
Hwan T. Hee, et al. Complications of Multilevel Cervical Corpectomies and Reconstruction With Titanium Cages and Anterior Plating. In Journal of Spinal Disorders. February 2003. Vol. 16. No. 1. Pp. 1-9.
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