Factors Related to Instrumentation Failure in Titanium Mesh Reconstruction for Thoracic and Lumbar Tumors: Retrospective Analysis of 178 Patients

Abstract

Purpose To investigate risk factors for instrumentation failure (IF) in titanium (Ti) mesh reconstruction for thoracic and lumbar tumors. Patients and Methods The clinical data of patients with thoracic or lumbar tumors who received Ti mesh reconstruction via the posterior approach in our hospital from 2013 to 2018 were analyzed retrospectively. The observation indexes included sex, age, BMI, the vertebra resection mode, the number of resected vertebral segments, application of bone cement, radiotherapy, chemotherapy, revision or primary surgery, and primary tumor metastasis. Correlations between these factors and IF were analyzed by Kaplan–Meier survival and logistics regression analyses. Results The 178 patients included 108 males and 70 females with a mean age of 48.09±16.21 (6–78) years and a mean follow-up period of 51.18 (24–90) months. The data showed that 17 patients (9.55%) were inflicted with IF, involving the thoracic vertebra in 11 cases, thoracolumbar vertebrae (T12–L1) in 2 cases, and lumbar vertebrae in 4 cases. The mean interval between surgery to IF was 35.18±14.17 (14–59) months. Univariate analysis showed that total vertebral body resection, the number of resected vertebral segments, radiotherapy and multiple tumor resection were potential factors for IF, while multivariate analysis showed that only total vertebral body resection, the number of resected vertebral segments and radiotherapy were independent factors. Conclusion Total vertebra resection, the number of resected vertebral segments (≥2) and radiotherapy before and after operation were significant risk factors related to IF.

Characteristics and risk factors of instrumentation failure following total en bloc spondylectomy

“…[7][8][9][10][11][12][13] Although previous studies showed that most IFs were posterior instrument breakage, the mechanism and preceding condition had not yet been investigated in detail. [8][9][10]12,14 In our study, most IFs after TES were rod fractures preceded by CS and following kyphotic enhancement of the reconstructed level. Hence, CS is the first event in the development of IF.…”

“…These reconstructions should be considered in patients with risk factors, such as lumbar level TES, multiple vertebral body resection, high BMI, and perioperative radiotherapy. [8][9][10]13,14 In addition, spinal shortening should be applied as this increases both the stability and blood flow of the spinal cord. 35,36 There are several limitations to our study.…”

“…[7][8][9][10][11][12][13] Several studies have focused on IF after TES, and established certain risk factors such as perioperative radiotherapy, TES in the lumbar spine, multiple vertebral body resection, high BMI, inappropriate cage position, and large cage subsidence (CS). [8][9][10]13,14 However, most of these studies have small sample sizes, and only a few have conducted a multivariate risk factor analysis using a sufficient sample size. Also, although the average time between TES and IF occurrence has been reported to be 30 months postoperatively, [8][9][10][11][12]14 the minimum follow-up period of these studies was ≤ 24 months, which could result in the incidence of IF and some IF-related analyses being skewed.…”

“…[8][9][10]13,14 However, most of these studies have small sample sizes, and only a few have conducted a multivariate risk factor analysis using a sufficient sample size. Also, although the average time between TES and IF occurrence has been reported to be 30 months postoperatively, [8][9][10][11][12]14 the minimum follow-up period of these studies was ≤ 24 months, which could result in the incidence of IF and some IF-related analyses being skewed.…”

Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis

“…Bao et al. ( 40 ) found that preoperative or postoperative radiotherapy and resection of more than 2 vertebral body segments were independent risk factors for implants failure. Radiotherapy does not cause fracture of bone collagen but changes the biomechanical characteristics of the bone matrix, resulting in reduced fatigue resistance ( 41 ).…”