Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

Kwon, Shin Won; Chung, Chun Kee; Won, Young Il; Yuh, Woon Tak; Park, Sung Bae; Yang, Seung Heon; Lee, Chang‐Hyun; Rhee, John M.; Kim, Kyoung‐Tae; Kim, Chi Heon

doi:10.14245/ns.2244092.046

Cited by 3 publications

(1 citation statement)

References 34 publications

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“…For instance, Matsumoto et al reported internal fixation failure in six out of 15 TES cases, with an average occurrence time of 28.3 months [ 4 ]. In a follow-up study by Kwon et al [ 21 ] mechanical failure was observed in three out of 19 patients with primary tumours (33%) and two patients with metastatic tumours (20%). In Liu et al [ 16 ] study, internal fixation breakage was observed in six out of 18 patients with giant cell tumours.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis

Han

Ren

et al. 2023

J Orthop Surg Res

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Background The influence of total en bloc spondylectomy (TES) on spinal stability is substantial, necessitating strong fixation to restore spinal stability. The transverse connector (TC) serves as a posterior spinal instrumentation that connects the left and right sides of the pedicle screw-rod system. Several studies have highlighted the potential of a TC in enhancing the stability of the fixed segments. However, contradictory results have suggested that a TC not only fails to improve the stability of the fixed segments but also might promote stress associated with internal fixation. To date, there is a lack of previous research investigating the biomechanical effects of a TC on TES. This study aimed to investigate the biomechanical effects of a TC on internal fixation during TES of the lumbar (L) spine. Methods A single-segment (L3 segment) TES was simulated using a comprehensive L spine finite element model. Five models were constructed based on the various positions of the TC, namely the intact model (L1-sacrum), the TES model without a TC, the TES model with a TC at L1–2, the TES model with a TC at L2–4, and the TES model with a TC at L4–5. Mechanical analysis of these distinct models was conducted using the Abaqus software to assess the variations in the biomechanics of the pedicle screw-rod system, titanium cage, and adjacent endplates. Results The stability of the surgical segments was found to be satisfactory across all models. Compared with the complete model, the internal fixation device exhibited the greatest constraint on overextension (95.2–95.6%), while showing the least limitation on left/right rotation (53.62–55.64%). The application of the TC had minimal effect on the stability of the fixed segments, resulting in a maximum reduction in segment mobility of 0.11° and a variation range of 3.29%. Regardless of the use of a TC, no significant changes in stress were observed for the titanium cage. In the model without the TC, the maximum von Mises stress (VMS) for the pedicle screw-rod system reached 136.9 MPa during anterior flexion. Upon the addition of a TC, the maximum VMS of the pedicle screw-rod system increased to varying degrees. The highest recorded VMS was 459.3 MPa, indicating a stress increase of 335.5%. Following the TC implantation, the stress on the adjacent endplate exhibited a partial reduction, with the maximum stress reduced by 27.6%. Conclusion The use of a TC in TES does not improve the stability of the fixed segments and instead might result in increased stress concentration within the internal fixation devices. Based on these findings, the routine utilisation of TC in TES is deemed unnecessary.

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Section: Discussionmentioning

confidence: 99%

Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis

Han

Ren

et al. 2023

J Orthop Surg Res

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Revisiting En Bloc Resection Versus Piecemeal Resection for the Treatment of Giant Cell Tumor of the Spine

Lee

Yoon

et al. 2023

World Neurosurgery

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Case Report: Does the misplaced titanium mesh cage after total spondylectomy causing cervicothoracic cord compression need to be removed during revision surgery?

Wang,

Cheng,

Zhao

et al. 2024

Front. Surg.

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BackgroundMechanical failure following total spondylectomy is a surgical challenge. The cervicothoracic junction region is a special anatomical site with complex biomechanics, and few studies have reported a detailed surgical management strategy for cases where the mesh cage subsides and compresses the spinal cord in the cervicothoracic junction region after total spondylectomy.Case presentationA 56-year-old male patient experienced screw and rod fracture and mesh cage retropulsion into the spinal canal 5 years after total spondylectomy for osteochondroma in the first to third thoracic vertebrae. The patient complained of numbness and discomfort in both lower extremities, accompanied by unstable walking for 8 months prior to admission at our hospital. We concluded that uncorrected local kyphosis in the cervicothoracic junction after the first surgery resulted in current mesh cage subsidence and rod/screw fracture. Considering the difficulty and risks of removing the mesh cage from the anterior approach, we initially freed the superior end of the mesh cage without removing the mesh from the anterior approach by resecting the C6/7 intervertebral disc and the destroyed C7 vertebral body. We then removed the original screws and rods and performed long segment fixation from C4 to T6 via a posterior approach after recovering sagittal alignment by skull traction. Finally, the iliac bone was harvested and transplanted between the superior end of the mesh cage and the inferior end plate of C6 to fill the defect caused by kyphosis correction and C7 vertebral resection. After surgery, the patient experienced sagittal alignment reconstruction and symptom relief, and he was asked to wear a cast for at least 6 months until bone fusion was achieved. At the 3-year follow-up, there was fusion between the mesh cage and the C6 vertebra with successful instrument reconstruction and no mesh cage subsidence were observed.ConclusionsWhen a subsided and migrated titanium mesh cage is difficult to remove after mechanical failure following total spondylectomy, recovering sagittal alignment to achieve indirect decompression based on unique anterior and middle column reconstruction, solid instrument construction, and bone fusion is an alternative solution.

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Mechanical Failure After Total En Bloc Spondylectomy and Salvage Surgery

Cited by 3 publications

References 34 publications

Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis

Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis

Revisiting En Bloc Resection Versus Piecemeal Resection for the Treatment of Giant Cell Tumor of the Spine

Case Report: Does the misplaced titanium mesh cage after total spondylectomy causing cervicothoracic cord compression need to be removed during revision surgery?

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