Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: A. Amelot

Author(s):

A. Amelot(1,2), J.-E. Loret(1)

(1) Bretonneau Hospital, Neurosurgery, Tours, France
(2) La Pitié Salpétrière, Neurosurgery, Paris, France

Abstract

Background: Beside recent studies advocating the interest of implant design in fusion and stability achievement for cervical spinal diseases, additive manufacturing has emerged over the past years. This study aims to describe the manufacturing process of patient-specific implants used in anterior cervical corpectomy and vertebral body replacement (VBR) and to evaluate the clinical and radiological outcomes in cervical spondylotic myelopathy (CSM).

Methods: Prospective clinical study. Six patients were implanted for single or multilevel CSM with patient-specific VBR in a single institution. Clinical scores (VAS, mJOA, NDI, EMS) and radiological measurements were collected.

Results: Six patients reached a mean of 21months follow-up (12 to 24). The C2-C7 Cobb angle and corpectomy Cobb angle remained constant during follow-up, without hyperlordosis deformation or kyphotic sliding. Anterior and posterior heights (Ha, Hp) of the corpectomy segment were constant (ratio close to 1) with no severe subsidence (>3mm) at last follow-up. No height difference between the preoperative and the last follow-up were found for upper Hp and Ha (0.97±.09 and 1.00±.06 respectively) nor lower adjacent vertebrates Hp and Ha (0.96±.04 and 1.02±.12). The mean mJOA and EMS recovery rates were 60.4%, (SD 20.4) and 77.0% (SD 29.7) at last follow-up respectively. EMS score of at least 16/18 was observed in 83% (5/6) of patients. Preoperative NDI score was 47.1% (SD 18.6) and improved to 11.2% (SD 4.1) at last follow-up (p< 0.01). Preoperative VAS neck (6.3; range 4- 7) and VAS arm (6.1; range 3- 9) scores improved respectively to (1.3; range 0-3) and (2.8; range 0-5) at last follow-up.

Conclusion: This first study enables to demonstrate the feasibility to use patient-specific implants in CSM treatment. The good radiological and clinical outcomes associated with a great achievement rate advocate the concept of a personalized therapy. These encouraging results have now to be confirmed over follow-up and with a larger cohort.