3D-printed titanium vertebra in the treatment of cervical spondylotic myelopathy: A comparative analysis of perioperative, radiographic, and clinical outcomes.

Abstract

<h4>Objective</h4>Anterior cervical corpectomy and fusion (ACCF) using a titanium mesh cage (TMC) is associated with a high rate of subsidence. This study aims to evaluate the potential advantages of utilizing 3D-printed titanium vertebrae as an alternative to TMC in ACCF procedures.<h4>Methods</h4>A retrospective analysis was conducted on patients who underwent ACCF at our hospital between March 2017 and June 2023. Patient demographics, surgical parameters (operation duration and blood loss), functional assessments (Barthel score, Morse Fall Scale (MFS), anterior cervical corpectomy index (aCCI)), hospitalization duration, costs, postoperative complications, unplanned reoperations, ICU admissions, and patient-reported outcomes (Japanese Orthopedic Association (JOA) score, Visual Analog Scale (VAS) score, Neck Disability Index (NDI) score) were recorded. Radiographic outcomes, including C2-C7 Cobb angles, segmental lordosis, and subsidence, were assessed via lateral cervical spine X-rays. Statistical analysis was performed using the Chi-square test and Mann-Whitney test.<h4>Results</h4>A total of 92 patients were included in the study, with 48 patients in the 3D-vertebra group and 44 in the TMC group. Baseline characteristics were comparable between groups. The 3D-vertebra group demonstrated significantly shorter operative time, reduced blood loss, and improved functional scores compared to the TMC group (p < 0.05). Postoperatively, the 3D-vertebra group exhibited lower JOA and VAS scores at both one-week and final follow-up. NDI scores were comparable at one week but were significantly higher in the TMC group at follow-up. While segmental lordosis remained similar between groups, C2-C7 Cobb angles showed significant differences at follow-up. The TMC group experienced an average subsidence of 2.5 mm, whereas the 3D-vertebra group had minimal subsidence.<h4>Conclusion</h4>The use of 3D-printed titanium vertebrae in ACCF surgery offers superior perioperative parameters, radiographic outcomes, and clinical scores compared to TMC implants. Further long-term studies are warranted to establish the extended benefits of 3D-printed vertebrae. Limitations should be considered when interpreting the findings, and prospective, randomized controlled studies are warranted to validate our conclusions.