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A carbon fiber stackable cage system is presented to promote the reconstruction of the anterior column after vertebrectomy or corpectomy in tumor and trauma surgery. Modularity, immediate stability, early fusion of the graft, radiolucency, and no risk of disease transmission are the main advantages of this system.
Reconstruction of the anterior column of the spine is required in many tumor and trauma procedures. Surgical approach options include anterior, posterior, and combined anterior and posterior.1 In a patient with a long-life expectancy, the spinal defect (te, fractures, their sequelae, and primary tumors) must be filled by a spacer capable of creating immediate and long-term stability, the optimal conditions for promoting a full bony fusion.
The Carbon Fiber Reinforced Polymer (CFRP) Stackable Cage System (DePuy Acromed Ine, Raynham, Mass) was designed in 1994 based on the theoretical advantages of this material2 and the successful experience of other CFRP implants, such as the Intervertebral Fusion Cage.3 The CFRP Stackable Cage is the most important component of a system that:
* provides a modular system able to fit different vertebral body resections,
* can be implanted by a posterior, anterior, or combined approach,
* promotes bone ingrowth within the cage and fusion with host bone, and
* facilitates a circumferential reconstruction that offers immediate stability for early full weight bearing.
The CFRP Stackable Cage System advances beyond the existing options. One existing option is cement. Cement is inexpensive and relatively easy to place in various defects. Its history dates to cases reported by Scoville et al4 and Harrington.5 Several techniques have described cement implanted freely or within silastic tubes, mostly associated with Steinmann pins or anterior plates.6,7 It is not indicated in traumatology, as it interferes with callus formation. Long-term reliability is questionable.8 Spine stability is only due to a fibrous scar or the combination of a metallic device; complele restoration of sagittal balance cannot be expected. Patients with short-life expectancy are best suited for acrylic cement replacement of the spinal defect.
Allografts represent the oldest and perhaps more common spacer used in oncologic surgery.9,10 They are relatively inexpensive, and segments of femoral shaft can be effectively customized to the defect after corpectomy. The healing process passes through creeping substitution, requiring a high grade of local stability....