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Anterior Cervical Intercorporal Fusion in Patients With Osteoporotic or Tumorous Fractures Using a Cement Augmented Cervical Plate System: First Results of a Prospective Single-center Study

Waschke, Albrecht MD; Walter, Jan MD; Duenisch, Pedro MD; Kalff, Rolf PhD; Ewald, Christian PhD

Journal of Spinal Disorders and Techniques: May 2013 - Volume 26 - Issue 3 - p E112–E117
doi: 10.1097/BSD.0b013e3182764b37

Study Design: Prospective observational clinical study.

Objective: The aim of this study is to evaluate the technical feasibility and the safety of additional cement augmentation of anterior cervical implants in patients with poor bone quality because of osteoporosis or tumor infiltration.

Summary of Background Data: With an increasing number of elderly patients in spinal surgery the problem of implant dislocation after cervical instrumentation will become a more and more important problem. Whereas in the thoracolumbar area cement augmented screws have become widely accepted to ensure a rigid fixation in patients with reduced bone quality there are no data concerning an additional intravertebral cement augmentation after cervical plating.

Methods: Nine patients (4 males, 5 females, mean age 62.8 y) with newly diagnosed fractures of 1 or 2 cervical vertebrae because of tumor infiltration (6 cases) or osteoporosis (3 cases) were included in our study. A standard 1-level or 2-level cervical corpectomy with vertebral body replacement by an in situ expandable titanium cage and additional anterior plating was carried out. After this, additional cement augmentation was performed as a vertebroplasty of the anterior two thirds of the cranial and caudal adjacent vertebra by a new anterior hole. The cement should enclose the screws and stabilize the endplates of the adjacent vertebrae. Follow-up comprised clinical examinations, SF-36 questionnaire and visual analog scale 3, 6, and 12 months after surgery. Cervical spine radiographs were obtained 3 and 6 months after surgery and computed tomography scans 6 and 12 months after surgery.

Results: The median follow-up was 10 months with a range of 4–18 months. There was no intraoperative cement leakage into the spinal canal. The visual analog scale decreased from 8.2 to 4.2 at 6 months, physical and mental component summaries of SF-36 increased significantly from 27.7 to 36.1 and 31.5 to 48.6 at 6 months, respectively. Loosening of screws or plates was not detected throughout the whole observation period. There was 1 subsidence of a titanium cage into an adjacent vertebra without any clinical consequences. There was no adjacent fracture during the follow-up period and other surgical interventions or revisions were not necessary in any patient.

Conclusions: In patients with severe osteoporosis or in patients with advanced tumor disease, excellent surgical, clinical, and radiologic results are possible following our method. In our opinion, a second-step posterior approach can be avoided by this technique.

Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany

Supported from National Institutes of Health (NIH), Wellcome Trust and Howard Hughes Medical Institute (HHMI).

The authors declare no conflict of interest.

Reprints: Albrecht Waschke, MD, Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, Jena 07747, Germany (e-mail:

Received June 6, 2012

Accepted September 26, 2012

© 2013 Lippincott Williams & Wilkins, Inc.