Spine fusion cross-link causing delayed dural erosion and CSF leak: case report

Rahmathulla, Gazanfar; Deen, H. Gordon

doi:10.3171/2014.9.spine14244

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…Additionally, How et al [ 30 ] identified TC application as a risk factor for pseudojoint formation in orthopaedic surgery for spinal deformities. Rahmathulla et al [ 31 ] reported that TCs might contribute to spinal stenosis and delayed cerebrospinal fluid leakage. In our study, the use of TCs in TES did not significantly affect the ROM in the fixed segment or generate greater stress at the adjacent endplate.…”

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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“…PRES is characterized by postural headaches, altered mental status, seizures, and visual disturbances, all of which resolved after revision with dural repair (21). Additionally, Rahmathulla et al described a case of delayed dural erosion from a crosslink causing postural headaches 11 years after index surgery (22). …”

Section: Discussionmentioning

confidence: 99%

Delayed Dural Leak Following Posterior Spinal Fusion for Idiopathic Scoliosis Using All Posterior Pedicle Screw Technique

Floccari¹,

Larson²,

Stans³

et al. 2017

Journal of Pediatric Orthopaedics

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Background In pediatric patients, pedicle screws are malpositioned 5–15% of the time. Complications associated with malpositioned screws are infrequently reported in the literature. We present a series of adolescent idiopathic scoliosis patients who presented in a delayed fashion with positional headache and chronic dural leak adjacent to the pedicle screw tract. Methods Scoliosis databases at two centers were reviewed, and cases of delayed positional headaches following posterior spinal fusion for adolescent idiopathic scoliosis were identified. Demographic and clinical data were collected. Results Out of 322 patients, four patients presented with positional headaches at a mean of 12.8 weeks following posterior spinal fusion surgery for AIS, with an interval time to diagnosis of 5 months. CT myelogram demonstrated severe pedicle screw malposition in one patient, and minimal malposition in three patients (less than 2mm violation). The patients had delayed presentation with positional headaches secondary to dural leak. All patients successfully underwent revision surgery with repair of the dural leak. At the time of latest follow-up, all patients are asymptomatic. Conclusion Pedicle screw malposition can result in dural leaks. Patients may present in a delayed fashion with positional headaches and an acquired Chiari malformation. Clinical suspicion should prompt imaging of the brain or cervical spine followed by CT myelogram to determine site of leak. This is a rare complication from pedicle screw malposition.

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“…Cross-links were primarily planned to increase and maintain the stability of the coronal plane in long-segment scoliosis surgery [11][12][13]. They can increase axial stress loading, prevent lateral bending and rod migration, and minimize the total number of pedicle screws inserted in long-segment fixation [14][15][16].…”

Section: Plain Language Summarymentioning

confidence: 99%

Skipping Cross Links in Posterior Spine Surgery: A Review

Shafizad

Haddadi

2020

Iran J Neurosurg

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Background and Aim: Given the conflicting and unreliable evidence for using cross-links in posterior spine surgery, this review was conducted to highlight the different features and usefulness of these augmentation devices in spine surgeries. Methods and Materials/Patients: After searching databases using specific keywords, the relevant articles were ultimately selected and evaluated. Results: Biomechanically investigating the use of cross-links has not resulted in unanimous explanations for their effect. The site and direction of cross-links have been rarely investigated in the literature. Some studies recommended eliminating their application from clinical practice; nevertheless, these studies do not necessarily yield clinical benefits. Posterior spinal fixation with pedicle screws and without cross-links offers stability in all the planes in most clinical conditions. Conclusion: Excluding the cross-links in posterior spine surgery may shorten the operation time and reduce hospital costs. Researchers have reported other problems for cross-links such as late pain, device failure, infections, device prominence, and pseudarthrosis which may be obliterated through the avoidance of their combination in a spinal construct; nevertheless, the results of animal models of the application of special cross-links in a degenerative disorder or deformity suggest that diagonal cross-links provide the highest stability of the construct if they are matched with a rodonly system or with transverse cross-link constructs resulting in a rectangular configuration.

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Spine fusion cross-link causing delayed dural erosion and CSF leak: case report

Cited by 4 publications

References 17 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

Delayed Dural Leak Following Posterior Spinal Fusion for Idiopathic Scoliosis Using All Posterior Pedicle Screw Technique

Skipping Cross Links in Posterior Spine Surgery: A Review

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