Cages with fixation wings versus cages plus plating for cervical reconstruction after corpectomy - is there any difference?

Aim: Different expandable and non-expandable fusion cages have gained acceptance in spinal surgery. We compared the radiological outcome of titanium cages with mounted wings to cages with additional anterior plating.

Methods: We performed a retrospective study of 44 patients after single or two-level cervical corpectomy. For reconstruction of the anterior column two different anterior distraction devices (ADD) were used: cage plus ventral plating (16 cases, ADD group) or cage with fixation wings (28 cases, ADDplus group). Clinical and radiological evaluations were performed after 1 week, 6 months and 12 months. Cervical lordosis, the angle between the adjacent vertebral bodies, the settling ratio, fusion rates, stability, neurological outcome and complications were assessed to compare both groups.

Results: Both groups had similar final clinical but different radiological outcomes. The fusion rate was 100% in the ADD group and 89% in the ADDplus group. Furthermore, the relative loss of cervical lordosis after 12 months was higher in the ADDplus group (-6.9% vs. -1.6%). The loss of correction of the relative rotation angle of the operated segment was also higher in the ADDplus group (-4.3 degrees vs. -1.7 degrees). Additional surgery was necessary in three cases in the ADDplus group.

Conclusions: This study demonstrates that expandable cages are useful vertebral body replacements, because they can be adjusted to the size of the corpectomy in situ and provide immediate strong anterior column support avoiding bone graft site morbidity. The direct attachment of fixation wings to the cage simplifies the operative procedure but carries a significantly higher risk of non-fusion, loss of lordotic correction and height.