Instrumented Spinal Stabilization without Fusion for Spinal Metastatic Disease

Abstract

Objectives Spinal stabilization surgery is an integral part of the treatment of spinal metastatic disease. Bony fusion is the hallmark of spinal stabilization in non-oncology patients. Spinal oncology patients are unlikely to achieve bony fusion due to their overall prognosis and concurrent therapies. Stabilization surgery without fusion may be a reasonable approach for these patients. Literature evaluating the effectiveness of this approach is limited. The object of this study was to investigate the rate of instrumentation failure in patients undergoing posterior spinal instrumented stabilization without fusion for spinal metastatic disease. Methods Data from consecutive cases of spinal surgery at our institution during an 81-month period were reviewed. Demographics, clinical notes, and computed tomography (CT) findings were recorded and used to evaluate instrumentation failures. Patients who underwent separation surgery that included laminectomy and posterior spinal instrumentation without fusion for spinal metastatic disease and had follow-up CT scans >3 months postoperatively were selected for the study. Results Twenty-seven patients were included in the study. Mean age was 64.85±6.53 years. Nine patients were women. A mean of 1.61±0.96 laminectomy levels was performed. A mean of 8.26±1.48 screws was inserted. The mean postoperative discharge date was 5.07±1.47 days. Mean follow-up duration was 12.17±11.73 months. None of the patients had a change in instrumentation position, pedicle screw pullout, change in spinal alignment, or progressive deformity. No patient required reoperation or instrumentation revision or replacement. Conclusions Our experience suggests that instrumented spinal stabilization without fusion is an acceptable approach for patients with spinal metastatic disease.

Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

“…They found that patients with prior or concomitant chest wall resection and a construct length that spanned more than six spinal segments were more likely to experience implant failure leading to revision surgery. In another review by Drakhshandeh et al [12], of 27 patients who underwent separation surgery with posterior spinal decompression and instrumentation without fusion, none developed implant failure in their postoperative follow-up as evidenced on CT scan; thus, no patient required revision surgery. In the review by Bellato et al [13], of 105 patients who underwent spinal decompression and fixation for the treatment of spinal metastases using a posterior approach, without attempted arthrodesis, nine patients (8%) developed implant failure, but none of these patients required revision surgery.…”

“…The quoted incidence of implant failure after surgery for spinal metastases is approximately 2%-8% [10][11][12][13][14][15]. Patients with implant failure may or may not be symptomatic, and not all patients with implant failure require further revision surgery [10].…”

“…Studies in the literature regarding implant failure after surgical stabilization of spinal metastasis are limited [10][11][12][13][14][15]; therefore, this study aims to investigate the incidence of implant failure after surgical stabilization of spinal metastasis with spinal instrumentation and analyze the potential risk factors in the development of implant failure.…”

Separation surgery for metastatic epidural spinal cord compression: A qualitative review

“…Drakhsandeh et al reported no hardware failure in a retrospective series of 27 patients undergoing posterior instrumentation without fusion, while the more reliable 7-years retrospective experience by Amankulor et al that analyzing 318 patients treated with posterior instrumentation without anterior column reconstruction reported 2.8% of hardware failure incidence, while instrumentation longer than 6 levels and chest wall resection resulted to be the risk factors for failure [87] , [88] , [89] . Cofano et al have recently reported no hardware failure in a retrospective series of patients undergoing posterior carbon fiber / PEEK instrumentation, with a mean follow up of 11 months [77] .…”

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

“…Of the 17 IF cases, 12 (70.6%) received TES ( Table 2 ), which is similar to that in patients with spinal metastases but significantly lower than that in TES patients reported in other studies. 14 , 15 , 17–20 Park et al reported 15 IF cases (12.1%) in 124 patients with spinal metastasis who underwent corpectomy with instrumentation. 6 Sciubba et al reported IF occurrence in 9 (39.1%) of their 23 patients who underwent TES at the lumbar spine.…”