Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Wong, Yu Chung; Chau, Wai‐Wang; Kwok, Kin On; Law, Sheung Wai

doi:10.31616/asj.2020.0034

Cited by 12 publications

(15 citation statements)

References 19 publications

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“…Seven studies [ 3 – 6 , 8 , 11 , 18 ] compared the spinal fixation failure rate between the older and younger subgroups. Values of I 2 = 0.0% and p = 0.945 were obtained after the OR values of the failure rate were merged, indicating that no heterogeneity existed.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Background No available meta-analysis has been published that systematically assessed spinal fixation mechanical failure after tumor resection based on largely pooled data. This systematic review and meta-analysis aimed to investigate the spinal fixation failure rate and potential risk factors for hardware failure. Methods Electronic articles published between January 1, 1979, and January 30, 2021, were searched and critically evaluated. The authors independently reviewed the abstracts and extracted data on the spinal fixation failure rate and potential risk factors. Results Thirty-eight studies were finally included in the meta-analysis. The pooled spinal fixation mechanical failure rate was 10%. The significant risk factors for hardware failure included tumor level and cage subsidence. Radiotherapy was a potential risk factor. Conclusion The spinal fixation mechanical failure rate was 10%. Spinal fixation failure is mainly associated with tumor level, cage subsidence and radiotherapy. Durable reconstruction is needed for patients with these risk factors.

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Section: Resultsmentioning

confidence: 99%

“…A total of 8 studies (including subgroups) [ 3 – 6 , 8 , 11 , 18 ] assessed the association between radiotherapy and failure rate. Values of I 2 = 56.0% and p = 0.415 were obtained after the OR values of the failure rate were merged, indicating that heterogeneity existed.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…But some scholars believed that implant failure had nothing to do with radiotherapy. For example, Wong et al 25 reported the occurrence of IF in 9(10.2%) of their 88 metastatic cancer cases and therefore believed that radiotherapy either before or after spinal operation was associated with a reduced incidence of implant failure. Some studies reported that the affected vertebra became recalcified 1–2 months after destruction of tumor cells by radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

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

Bao¹,

Jia²,

Wang³

et al. 2021

CMAR

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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.

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“…[ 4 , 5 ] A common typical complication after instrumentation addressed by various authors is loosening of the screws with related material failure, with a range from 1% to 15% up to 63%. [ 6 , 7 ]…”

Section: Introductionmentioning

confidence: 99%

Indications for early revision surgery for material failure in spinal instrumentation: experience at a level 1 center for spinal surgery – a single-center study

Banat¹,

Wach²,

Salemdawod³

et al. 2021

Medicine

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Posterior instrumentation is an established treatment for a range of spinal disorders. Material failure is not uncommon, and the indications for a revision are very heterogeneous. This study aimed to evaluate the indications and timing for early revision spinal surgery due to material failure. In this retrospective, single-center cohort study, patients underwent spinal posterior instrumentation between January 2017 and July 2019. They were followed up at 3, 12, and 18 months postoperatively. The time of onset of material failure which led to revision surgery was analyzed. In addition, the relationship between the indications for revision surgery and independent variables was examined using a multivariate logistic regression model. A total of one hundred thirty-five patients were enrolled. Radiolucent zones were found in 30 patients (20%) after 3 months, whereas 48 patients (31%) had radiolucent zones after 12 months. Revision surgery was performed in 13 patients (8.5%). The peak time for revision due to instability was within the first four months of the primary surgery. Multivariate analysis revealed that location, pathology, ASA score, and smoking had no significant impact on the indication for revision surgery, and neither did BMI ( P = .042). Non-fusion ( P = .007) and radiolucent zones ( P = .004), in combination with increased pain ( P = .006), were predictors for revision. Our data show that the peak time for early revision of material failure after posterior instrumentation was within the first 4 months of primary surgery. The abnormalities (e.g., radiolucent zones) surrounding the screws without fusion, including persistence of pain, were predictors for revision surgery.

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Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Cited by 12 publications

References 19 publications

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

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

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

Indications for early revision surgery for material failure in spinal instrumentation: experience at a level 1 center for spinal surgery – a single-center study

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