Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 101-102

Calcifying posterior longitudinal ligamentum and posterior osteophytes in case of anterior cervical corpectomy with titanium cage reconstruction


1 Department of Neurosurgery, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
2 Department of Orthopedics, Narayana Dental College Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication10-Nov-2016

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-2585.193850

Rights and Permissions

How to cite this article:
Agrawal A, Gopalkrishnaiah T. Calcifying posterior longitudinal ligamentum and posterior osteophytes in case of anterior cervical corpectomy with titanium cage reconstruction. J Orthop Allied Sci 2016;4:101-2

How to cite this URL:
Agrawal A, Gopalkrishnaiah T. Calcifying posterior longitudinal ligamentum and posterior osteophytes in case of anterior cervical corpectomy with titanium cage reconstruction. J Orthop Allied Sci [serial online] 2016 [cited 2019 Dec 11];4:101-2. Available from: http://www.joas.in/text.asp?2016/4/2/101/193850

Dear Sir,

Anterior cervical corpectomy with titanium cage reconstruction is one of the effective methods of cervical spine reconstruction. [1],[2],[3] A 58-year-old male patient who was operated 2 years back for cervical disc disease was apparently doing well. Now, he presented with burning sensation and persistence of paresthesias. There was no history of weakness. There was no history of bowel and bladder disturbances. On examination, the motor and sensory systems were normal. Deep tendon reflexes were normal. Planters were bilateral flexors. His cervical spine X-ray showed titanium cage in-situ with good fusion [Figure 1]aHowever, there was ossification of the posterior longitudinal ligament with osteophytes. Magnetic resonance imaging of the cervical spine confirmed the ossified longitudinal ligament with mild thecal compression [Figure 1]b. In the absence of features of myelopathy, the patient was planned for conservative management and regular follow-up.
Figure 1: (a) X-ray of the cervical spine lateral view showing titanium cage in situ with good and solid bony fusion at C3-C4 level, note the posterior osteophytes and ossified ligamentum, (b) Magnetic resonance imaging T2-weighted image showing mild cord compression and calcified ligamentum

Click here to view


The major advantages of titanium cages are immediate stability, restoration of foraminal height and alignment, restoration of anatomic cervical lordosis at the intervertebral segment, and less operative time. [4],[5],[6] At present, the patient had good fusion as per the criteria described on plain radiograph (segmental movement in the lateral flexion-extension view should stand within 2°, formation of trabecular bone between allograft or cage and adjacent vertebral body and disappearance of the adjacent vertebral body endplate, effacement of bony spur, and remodeling of graft bone). [6],[7],[8],[9],[10] Although titanium cage has good outcome, there are few limitations: (1) their high modulus of elasticity contributes to subsidence and kyphotic deformity of the involved segment, [6],[10],[11],[12],[13],[14],[15] (2) cage malplacement, [3] and (3) cage extrusion. [6] Although clinical outcomes of the stand-alone cage have been shown to be encouraging, cage subsidence is a major concern as its complications [Figure 2]. [15] If a patient with titanium cage in situ and radiological evidence of good fusion requires a revision surgery, it can be extremely difficult. [16] The cage extraction from a corpectomy site also requires a significant amount of drilling of above and below vertebral bodies. [16] In contrary to the problem of cage subsidence, the present patient had ossified posterior longitudinal ligament and posterior osteophytes (although may not be responsible for his symptomatology). As he did not have deficits related to the involved segments, he was counseled accordingly and managed conservatively.
Figure 2: X-ray of the cervical spine lateral view of another patient showing titanium cage subsidence

Click here to view


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shams S, Rashid MJ. Anterior cervical reconstruction using titanium mesh cages. J Ayub Med Coll Abbottabad 2007;19:23-5.  Back to cited text no. 1
    
2.
Hida K, Iwasaki Y, Yano S, Akino M, Seki T. Long-term follow-up results in patients with cervical disk disease treated by cervical anterior fusion using titanium cage implants. Neurol Med Chir (Tokyo) 2008;48:440-6.  Back to cited text no. 2
    
3.
Chuang HC, Cho DY, Chang CS, Lee WY, Jung-Chung C, Lee HC, et al. Efficacy and safety of the use of titanium mesh cages and anterior cervical plates for interbody fusion after anterior cervical corpectomy. Surg Neurol 2006;65:464-71.  Back to cited text no. 3
    
4.
Tienboon P, Tienboon S. Comparing anterior cervical fusion using titanium cage with hydroxyapatite and with autograft. Asian Biomed 2010;4:147-52.  Back to cited text no. 4
    
5.
Wilke HJ, Kettler A, Goetz C, Claes L. Subsidence resulting from simulated postoperative neck movements: An in vitro investigation with a new cervical fusion cage. Spine (Phila Pa 1976) 2000;25:2762-70.  Back to cited text no. 5
    
6.
Majd ME, Vadhva M, Holt RT. Anterior cervical reconstruction using titanium cages with anterior plating. Spine (Phila Pa 1976) 1999;24:1604-10.  Back to cited text no. 6
    
7.
Lee CJ, Rhee DY, Heo W, Yoon JW, Park HS. The advantages of rectangular titanium cage (RABEA) fusion after anterior cervical discectomy: Comparative study of fibula allograft. J Korean Neurosurg Soc 2004;36:448-53.  Back to cited text no. 7
    
8.
Hacker RJ. A randomized prospective study of an anterior cervical interbody fusion device with a minimum of 2 years of follow-up results. J Neurosurg 2000;93 2 Suppl: 222-6.  Back to cited text no. 8
    
9.
Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine (Phila Pa 1976) 2000;25:2646-54.  Back to cited text no. 9
    
10.
Chou YC, Chen DC, Hsieh WA, Chen WF, Yen PS, Harnod T, et al. Efficacy of anterior cervical fusion: Comparison of titanium cages, polyetheretherketone (PEEK) cages and autogenous bone grafts. J Clin Neurosci 2008;15:1240-5.  Back to cited text no. 10
    
11.
Hakalo J, Pezowicz C, Wronski J, Bedzinski R, Kasprowicz M. The process of subsidence after cervical stabilizations by cage alone, cage with plate and plate-cage. A biomechanical comparative study. Neurol Neurochir Pol 2007;41:411-6.  Back to cited text no. 11
    
12.
Moreland DB, Asch HL, Clabeaux DE, Castiglia GJ, Czajka GA, Lewis PJ, et al. Anterior cervical discectomy and fusion with implantable titanium cage: Initial impressions, patient outcomes and comparison to fusion with allograft. Spine J 2004;4:184-91.  Back to cited text no. 12
    
13.
Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine 2006;4:447-53.  Back to cited text no. 13
    
14.
van Jonbergen HP, Spruit M, Anderson PG, Pavlov PW. Anterior cervical interbody fusion with a titanium box cage: Early radiological assessment of fusion and subsidence. Spine J 2005;5:645-9.  Back to cited text no. 14
    
15.
Wu WJ, Jiang LS, Liang Y, Dai LY. Cage subsidence does not, but cervical lordosis improvement does affect the long-term results of anterior cervical fusion with stand-alone cage for degenerative cervical disc disease: A retrospective study. Eur Spine J 2012;21:1374-82.  Back to cited text no. 15
    
16.
He M, Xiao Z, Li S, Chen Q. Application of anterior decompression and reconstruction using titanium mesh with locking plates in the management of cervical spondylotic myelopathy. J Nanjing Med Univ 2008;22:260-4.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
References
Article Figures

 Article Access Statistics
    Viewed486    
    Printed8    
    Emailed0    
    PDF Downloaded83    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]