Expandable titanium cages for thoracolumbar vertebral body replacement: initial clinical experience and review of the literature.

Reconstruction of the anterior and middle column after vertebrectomy is essential for restoring stability. Use of expandable implants is supported by an emerging body of literature. Newer expandable cages have some advantages over traditional mesh implants, structural allograft, and polyetheretherketone or carbon fiber cages. To determine the utility of an expandable titanium cage in spine reconstruction, we conducted a retrospective cohort study of patients who had undergone this reconstruction after single or multilevel thoracic and/or lumbar vertebrectomy. Here we report on our experience using expandable cages at 2 large academic medical centers. Outcome was based on both clinical and radiographic measures with cross-sectional analysis. Thirty-five patients were identified. Of these, 20 had undergone surgery for neoplasm, 8 for trauma, and 7 for infection. Mean follow-up was 31 months (range, 12 to 50 months). Early postoperative kyphosis correction, restoration of sagittal alignment at 12 months, and reduction in visual analog scale pain score were significant. There was no difference in Oswestry Disability Index or height restoration. Expandable intervertebral body strut grafts appear to be a safe and effective option in spine reconstruction after a vertebrectomy and should be considered a treatment option.