Risk Factors for Instrumentation Failure After Total En Bloc Spondylectomy of Thoracic and Lumbar Spine Tumors Using Titanium Mesh Cage for Anterior Reconstruction

Li, Zhehuang; Wei, Feng; Liu, Zhongjun; Liu, Xiaoguang; Jiang, Liang; Yu, Miao; Xu, Nanfang; Wu, Fan; Dang, Lei; Zhou, Hua; He, Jingliang

doi:10.1016/j.wneu.2019.11.057

Cited by 26 publications

(69 citation statements)

References 32 publications

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“…This factor may be the reason that TMC subsidence did not occur during the follow-up in our study; (3) Achieving solid bone fusion was vital to maintaining long-term stability for spinal reconstruction [24]. In the presence of pseudarthrosis, rod breakage may be inevitable due to metal fatigue caused by repeated fretting [24]. According to Wolff's laws, mechanical forces in uence bone formation and remodeling [27].…”

Section: Discussionmentioning

confidence: 80%

“…The use of additional accessory rods increases the stiffness of the instrumentation, which results in improved load transfer to the posterior construct, thereby reducing the load acting on the anterior device [13]. This factor may be the reason that TMC subsidence did not occur during the follow-up in our study; (3) Achieving solid bone fusion was vital to maintaining long-term stability for spinal reconstruction [24]. In the presence of pseudarthrosis, rod breakage may be inevitable due to metal fatigue caused by repeated fretting [24].…”

Section: Discussionmentioning

confidence: 85%

“…A biomechanical study demonstrated that multi-segmental posterior xation with anterior column reconstruction can provide better stability than short xation and that xation should be extended to 2 ~ 3 levels above and below the resected vertebrae [23]. However, instrumentation failure, the incidence of which varies from 17.0-40%, is not a rare complication following a long-segment xation procedure after TES [7,13,24,25]. Among the types of IF, such as screw loosening, screw backout, cage breakage, screw fracture, and rod breakage, rod fracture is the most common and often leads to a high reoperation rate due to aggravating back pain or neurologic deterioration [9,24].…”

Section: Discussionmentioning

confidence: 99%

“…However, instrumentation failure, the incidence of which varies from 17.0-40%, is not a rare complication following a long-segment xation procedure after TES [7,13,24,25]. Among the types of IF, such as screw loosening, screw backout, cage breakage, screw fracture, and rod breakage, rod fracture is the most common and often leads to a high reoperation rate due to aggravating back pain or neurologic deterioration [9,24]. Cage subsidence, a history of radiotherapy, and a low spinal level of involvement have been con rmed to be risk factors related to rod fracture [7,9,24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Among the types of IF, such as screw loosening, screw backout, cage breakage, screw fracture, and rod breakage, rod fracture is the most common and often leads to a high reoperation rate due to aggravating back pain or neurologic deterioration [9,24]. Cage subsidence, a history of radiotherapy, and a low spinal level of involvement have been con rmed to be risk factors related to rod fracture [7,9,24,25]. The survival time of spinal tumor patients is longer when primary tumors and metastatic tumors are resolved, so reconstruction of the three columns of the spine with additional posterior column reconstruction is very important [19].…”

Section: Discussionmentioning

confidence: 99%

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Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

Wei

Dong

et al. 2020

Preprint

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Background: To evaluate the clinical outcomes of total en bloc spondylectomy (TES) combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors.Methods: The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with satellite rod technique by a single posterior approach from June 2015 to September 2018were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH) and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI) and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded.Results: The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI and ASIA scores significantly improved from before to after surgery (P<0.05). The LKA, AVH and PVH significantly improved from before to immediately after surgery and to the final follow-up (P<0.05), and the postoperative and final follow-up values did not significantly differ (P>0.05).Conclusions: TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.

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Section: Discussionmentioning

confidence: 80%