Abstract
Since 1985 an original cementless, stainless prosthesis for C3-C7 cervical vertebral body substitution has been in use, fixed to contiguous vertebral bodies with screws. The prosthesis was employed in 151 patients, who were mostly affected by cervical metastases involving intractable pain with signs of nerve-root and/or myelon compression, using a permanent collar.
The use of this kind of prosthesis allowed a easy and quick surgery with early post-surgical mobilisation of the patient without any external support. Cervical pain resolution was very evident in all patients. Cervical substitution did not affect the prognosis of tumour but allowed a better nursing and quality of life of these patients. At a follow-up of 2.5 years we have not observed any prosthesis mobilisation.
In the last year some modifications were added to the prosthesis. Overall the prothesis was made of titanium, produced in two fashions, closed and open, and different lengths. The closed prosthesis is employed according to the indications of the previous prosthesis (in cases of corporectomy in neoplasms). The second one, open and empty, is filled with bone chips (autologous or etherologous) to achieve fusion with sorrounding vertebral bodies. Indications for the last type was corporectomy for discoarthrosis at two contiguous levels in patients in whom the intermediate vertebra were removed to assure a complete and safe cord decompression. The open prosthesis could also be used in burst fractures, avoiding other systems that require an anterior plate. The implantation technique presents no difficulties and can be easily incorporated into the group of standard surgical procedures for anterior interbody fusion.
We have used the prosthesis in 11 cases. The new titanium prothesis was easy to handle and provided immediate stability in all cases. Clinical and radiological follow-up examinations were performed at the time of discharge from hospital, and 3 and 6 months postoperatively. The clinical outcome was good or excellent in all the cases performed. On X-rays there was no implant migration or dislocation at the last follow-up and, to date, in CT reconstruction no insufficient fusion or pseudarthrosis has been observed. We cannot report any local complication. Results were promising and encouraging at a short-term control. Follow-up will be continued.
