African first: Capraia-Z cages used in neck surgery at Mediclinic Hermanus

The revolutionary Capraia-Z 3D printed titanium cages with built-in fixation reduce operating time and offer numerous surgical benefits in neck surgery.

 In a first for Africa, Dr Lizet Louw-Marais, a neurosurgeon at Mediclinic Hermanus, used the new cage during a successful procedure at the end of last year.

Understanding anterior cervical discectomy and fusion (ACDF)

The ACDF procedure is a neck surgery that involves removing a damaged disc between the vertebrae in the neck. It’s performed to relieve spinal cord or nerve root pressure and alleviate side-effects like pain, weakness, numbness, and tingling. A key requirement of the ACDF procedure is the insertion of instrumentation to stabilise the site of disc removal. 

“In this procedure, we operate from the front of the neck, which provides direct vision,” Dr Louw-Marais explains. “From the front, you take out the disc between the bones completely and you put in that special instrumentation, in this case the Capraia-Z cage. The purpose is to maintain a certain height between the vertebra, which is important for the nerves to exit at this specific space and is also important to promote fusion between the bones.”

The patient in question required the surgery as he had severe neck pain as well as weakness in his hands because of compression of his C6 nerve roots, Dr Louw-Marais says. “This was caused by an injury on duty at his workplace where he was hit in the face by a cord. During his successful surgery, two cages were inserted.”

What sets the Capraia-Z cage apart?

The Capraia-Z cage, developed by Tsunami Medical and distributed by Creatori Health, differs from other cages on the market that require different mechanisms to stay in place. “In the past, they put a plate on the front of the vertebrae, which would keep everything stable,” Dr Louw-Marais explains. “Then the cage would be placed without any fixation onto the vertebrae.”

The manufacturers worked to develop a standalone cage that didn’t require a plate, but rather screws that go through the cage to the top and the bottom of the vertebral body, keeping it in place. The new Capraia-Z cage stands apart because it has blades or pins on the top and bottom that are automatically deployed when the cage is placed into position. This secures the instrumentation and eliminates the need for screws and the X-ray screening that would normally be required.

Patient benefits

“With the new cage, much less time is needed to perform the operation, which means less chance of wound infection and trauma,” explains Dr Louw-Marais.

This reduces operating time by at least 30 minutes and lowers the risks to the patient, who is exposed to less radiation, she continues. “With inserting screws, you also have a higher risk of damaging surrounding structures with the tools because space is limited. With this device, you insert it, deploy it and that’s it. There is no more trauma to the surrounding structures.” Patients are also exposed to anaesthetics for a shorter period, which may help shorten their postoperative recovery.

The porous Capraia-Z titanium cages are easy to insert and secure, and their design adapts to closely match the properties of the patient’s existing anatomy. This eases and increases the rate of fusion into the neck.

“I’m very happy with the results as the patient’s issues have been resolved,” Dr Louw-Marais says. “I think the Capraia-Z cages are definitely going to make a big difference in the way this type of operation is being done in future because they’re straightforward and technically so much easier to use.”