Aim: We present a case report and the histological analysis of cage failure following vertebral body replacement in Hodgkin's disease.
Method: In a 35-year-old patient with a single metastasis of Hodgkin's disease replacement of the third lumbar vertebral body (Harms-titanium-mesh-cage, DePuy Acromed, completely filled with autogenous spongiosa from the iliac crest) was performed. 51 months postoperatively, the patient presented with acute back pain without trauma. The X-ray showed a collapse of the Harms-titanium-mesh-cage. The cage fragments had caused ventral dislocation of the main blood vessels and dura compression without neurological deficits. After the replacement of the failed Harms-cage (Synex, Synthes) histological analysis (light microscope, non-decalcified horizontal cuts, thickness of 150-200 microm, Giemsa und van Gieson staining) was done.
Result: The histology showed a remodelling of new bone in the area of the endplates without contact to the cage wall. In the region of the cage corpus, bony necrosis and connective tissue rich in cells was found.
Conclusion: Bridging fusion in vertebral body replacement cages is not proven. As a result cage failure may occur. Therefore, in tumour patients with high live expectancy, Palacos filling of the cages should be discussed.