Long-term Titanium mesh cage implant failure after total en bloc spondylectomy due to spinal chondrosarcoma

Objective: To report an unusual titanium mesh cage failure after ten years of follow-up.

Clinical case: A 40-year-old woman diagnosed with low-grade spinal chondrosarcoma underwent a total en-bloc spondylenctomy (TES) surgery. This technique required a wide resection, anterior reconstruction with a titanium mesh cage (TMC), and posterior stabilization. For several years a favorable clinical outcome was achieved. After 10 years of follow-up, the patient developed acute non-traumatic low back pain without neurological repercussions. The images confirmed a rupture of the titanium cage. After ruling out tumor recurrence, the patient went through spinal instrumentation revision.

Conclusion: Isolated TMC rupture is a rare event scarcely reported in the literature. There is a strong recommendation to instrument two levels proximal and distal to the bone defect in 360° reconstructions after a TES. Stability had likely been lost over the years due to the slow resorption of the bone graft. We consider necessary studies with a higher casuistry and level of evidence to analyze the contributing factors for the event of TMC rupture.