Factors associated with spinal fixation mechanical failure after tumor resection: a systematic review and meta-analysis

Cai, Zhenyu; Zhao, Yongzhao; Tang, Xiaodong; Yang, Rongli; Yan, Taiqiang; Guo, Wei

doi:10.1186/s13018-022-03007-6

Cited by 9 publications

(4 citation statements)

References 36 publications

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“…For the size of this bending moment, the present results, in addition to being in the range of the results in previous studies, showed the possibility that relatively large bending moments act on the rod even with an axial compressive load of 700 N alone. In clinical cases, many reports have described rod damage or breakage associated with long fixation, such as spinal stenosis surgery, osteotomy, and circumferential spinal osteotomy [ 11 - 13 ]. Based on our results, high bending stress may act on the rod even in the early postoperative period with limited lumbar flexion and other movements, in patients with such considerable instability, and consideration should be given to the design and selection of rods and screws.…”

Section: Discussionmentioning

confidence: 99%

Experimental Study of Failures of the Rigid Spinal Posterior Fixation System Under Compressive Load Conditions: A Cadaver Study

Kato,

Inaba,

Baba

et al. 2024

Cureus

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Background Many studies have been conducted on the biomechanics of the spine to elucidate the fixation properties of spinal fusion surgery and the causes of instrumentation failure. Among these studies, there are some studies on load sharing in the spine and measurement using strain gauges and pressure gauges, but there is a lack of research on axial compressive loads. Methods Axial compressive load tests were performed on human cadaveric injured lumbar vertebrae fixed with pedicle screws (PS). Both the strain generated in the PS rod and the intradiscal pressure were measured. Subsequently, the stress generated in the PS rod and the load sharing of the spine and instrumentation were calculated. Results Even when only compressive load is applied, bending stress of more than 10 times the compression stress was generated in the rod, and the stress tended to concentrate on one rod. Rod deformation becomes kyphotic, in contrast to the lordotic deformation behavior of the lumbar spine. The stress shielding rate was approximately 40%, less than half. Conclusions This study obtained basic data useful for constructing and verifying numerical simulations that are effective for predicting and elucidating the causes of dislodgement and failure of spinal implants.

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Section: Discussionmentioning

confidence: 99%

Experimental Study of Failures of the Rigid Spinal Posterior Fixation System Under Compressive Load Conditions: A Cadaver Study

Kato,

Inaba,

Baba

et al. 2024

Cureus

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“…Spinal instrument fractures were most common (4.4%). The mechanical failure of spinal instruments is reported to be 2.0–10% [ 7 , 8 ]. On the other hand, the mechanical failure of a magaprosthesis is reported to be 11.7% [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Iodine-supported implants in prevention and treatment of surgical site infections for compromised hosts: a prospective study

et al. 2023

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Background Surgical site infection (SSI) is a common complication following orthopedic implantation. We developed an iodine coating for titanium implants to reduce implant-related infections and conducted a prospective clinical study to evaluate the efficacy and potential drawbacks of iodine-supported implants. Patients and methods Between July 2008 and July 2017, 653 patients (377 male and 27 female patients; mean age, 48.6) with postoperative infection or a compromised status were treated using iodine-loaded titanium implants. The mean follow-up period was 41.7 months. In 477 patients, iodine-supported implants were used to prevent infection and in 176 patients, to treat active infection (one-stage surgery, 89 patients; two-stage surgery, 87 patients). In the limbs and pelvis, the primary diagnoses included the following: 161 tumors, 92 deformities/shortening, 47 pseudarthrosis, 42 fractures, 32 infected TKA, 25 osteoarthritis, 21 pyogenic arthritis, 20 infected THA, and 6 osteomyelitis. In the spinal cases, there were 136 cases of tumors, 36 cases of pyogenic spondylitis, and 35 cases of degeneration. Five modes of implant failure were identified and classified as follows: soft tissue failure (type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4), and tumor progression (type 5). Results The overall failure rate in our series was 26.3% (172/653). There were 101 mechanical failures, including 22 type 1, 20 type 2, and 59 type 3 failures. Non-mechanical causes accounted for 71 failures, including 45 type 4 and 26 type 5 failures. The overall incidence of infections was 6.8%. The mean time to the onset of infection after implantation was 9.1 months. The overall infection rate was 3.7% in the prevention cases and 15.3% in the treatment cases. There was no difference between one-stage replacement (14.6%) and two-stage replacement (16.0%). There were 11 cases of treatment for SSI of spine surgery, and the re-infection rate was 0% using iodine-coated instruments. Conclusions The five modes of failure of the iodine-supported implant were satisfactory compared with previous reports. In particular, because the infection rate of iodine-coated implants used for compromised hosts is low compared with other methods, postoperative infection is more easily controlled. It can be considered highly effective for spinal infections that require one-stage revision surgery. Level of evidence IV. Trial registration Prospective, Observation study.

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“…Spinal instrument fractures were most common (4.4%). The mechanical failure of spinal instruments is reported to be 2.0-10% [7,8]. On the other hand, the mechanical failure of a magaprosthesis is reported to be 11.7% [9].…”

Section: Discussionmentioning

confidence: 99%

Iodine-coated implants in prevention and treatment of surgical site infections for compromised hosts: A prospective study.

Shirai

Tsuchiya

Terauchi

et al. 2023

Preprint

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Background Surgical site infection (SSI) is a common complication following orthopedic implantation. We developed an iodine coating for titanium implants to reduce implant-related infectionsand conducted a prospective clinical study to evaluate the efficacy and potential drawbacks of iodine-coated implants. Patients and Methods Between July 2008 and July 2017, 653 patients (377 male and 27 female patients; mean age, 48.6) with postoperative infection or a compromised status were treated using iodine-loaded titanium implants. The mean follow-up period was 41.7 months. In 477 patients, iodine-supported implants were used to prevent infection and in 176 patients, to treat active infection (one-stage surgery, 89 patients; two-stage surgery,87 patients). In the limbs and pelvis, the primary diagnoses included the following: 161 tumors, 92 deformities/shortening, 47 pseudarthrosis, 42 fractures, 32 infected TKA, 25 osteoarthritis, 21 pyogenic arthritis, 20 infected THA, and 6 osteomyelitis. In the spinal cases, there were 136 cases of tumors, 36 cases of pyogenic spondylitis, and 35 cases of degeneration. Five modes of implant failure were identified and classified as follows: soft tissue failure(type 1), aseptic loosening (type 2), structural failure (type 3), infection (type 4), and tumor progression (type 5). Results The overall failure rate in our series was 26.3% (172/653). There were 101 mechanical failures, including 22 type 1, 20 type 2, and 59 type 3 failures. Non-mechanical causes accounted for 71 failures, including 45 type 4 and 26 type 5 failures. The overall incidence of infections was 6.8%. The mean time to the onset of infection after implantation was 9.1 months. The overall infection rate was 3.7% in the prevention cases and 15.3% in the treatment cases. There was no difference between one-stage replacement (14.6%) and two-stage replacement (16.0%). There were 11 cases of treatment for SSI of spine surgery, and the re-infection rate was 0% using iodine-coated instruments. Conclusions The five modes of failure of the iodine-coated implant were satisfactory compared with previous reports. In particular, because the infection rate of iodine-coated implants used for compromised hosts is low compared with other methods, postoperative infection is more easily controlled. It can be considered highly effective for spinal infections that require one-stage revision surgery. Level of Evidence: IV Trial registration: prospective, observation study

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Factors associated with spinal fixation mechanical failure after tumor resection: a systematic review and meta-analysis

Cited by 9 publications

References 36 publications

Experimental Study of Failures of the Rigid Spinal Posterior Fixation System Under Compressive Load Conditions: A Cadaver Study

Experimental Study of Failures of the Rigid Spinal Posterior Fixation System Under Compressive Load Conditions: A Cadaver Study

Iodine-supported implants in prevention and treatment of surgical site infections for compromised hosts: a prospective study

Iodine-coated implants in prevention and treatment of surgical site infections for compromised hosts: A prospective study.

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