Retrospective analysis of outcomes following expandable titanium cage and iliac graft applications in patients undergoing corpectomy for cervical spinal canal stenosis

Introduction This study aimed to compare the clinical and radiological outcomes of iliac crest autografts and expandable titanium cages in anterior cervical column reconstruction among patients undergoing cervical corpectomy for cervical spinal stenosis. Methods A retrospective analysis of 93 patients who underwent anterior cervical corpectomy between 2016 and 2023 was conducted; 61 were treated with iliac grafts and 32 with expandable cages. Clinical efficacy was assessed using the modified Japanese Orthopaedic Association (mJOA) score, while radiological outcomes were evaluated by measuring cervical lordosis (C2-C7 Cobb angle), intervertebral height, and fusion status, three months post-surgery. Complications, operative duration, and revision surgery rates were also analysed. Results Both the iliac graft and cage groups demonstrated significant postoperative improvements in mJOA scores (p<0.001). The iliac graft group exhibited superior early correction of cervical kyphosis, with the Cobb angle increasing from 3.17° to 9.12° (p<0.001), compared with the cage group’s increase from 0.99° to 5.83° (p=0.025). Cervical alignment remained more stable over time in the iliac graft group. Complication rates were comparable between the groups; however, graft displacement occurred more frequently in the iliac graft group. In contrast, cage malposition occasionally necessitated revision surgery. Conclusion Both iliac grafts and expandable cages are effective for anterior cervical reconstruction, yielding comparable clinical outcomes and complication rates. Iliac grafts may be better suited for achieving immediate postoperative correction and maintaining stable long-term alignment. The choice of surgical technique should take into account specific patient needs and the distinct risk profiles associated with each method.