Survivorship Analysis of Pedicle Spinal Instrumentation

McAfee, Paul C.; Weiland, Derek; Carlow, John J.

doi:10.1097/00007632-199108001-00023

Cited by 94 publications

(54 citation statements)

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“…The failure rates ranged from 0.4 to 22% [10][11][12][13][14][15][16][17]. Interestingly, some characteristics of the implant failures in this study differed from those involving lumbar or thoracolumbar fusions reported in the literature.…”

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 59%

“…Jutte et al [16] reported a 0.9% incidence of rod failure in 105 lumbar or lumbosacral fusions, and in most other reports, rod fractures occurred after posterior lumbar fusion surgery. Intraoperative rod contouring and corrective procedures using reduction devices are generally thought to be risk factors for the failure of spinal constructs, particularly with pure titanium or titanium alloy implants because of their notch sensitivity [10,18,19]. One reason that no rod fracture was observed in our cohort may be that we tried as much as possible to avoid bending the rod, taking maximal advantage of the polyaxial screw and offset connecting device (Fig.…”

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 99%

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Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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Purpose The aim of this study was to determine whether the recent refinement and downsizing of the implants for posterior cervical fusion increase the occurrence of implant failure. Methods One hundred forty-two consecutive cases of cervical fusion, using either cannulated Magerl screws or a multiaxial pedicle screw-rod system, were reviewed retrospectively after an average follow-up period of more than 3 years, and the rate and characteristics of the failure of these implants were evaluated. Results Implant failure occurred in six (4.2%) patients: five with rheumatoid arthritis and one with athetoid cerebral palsy. Occipital plate fracture occurred in two patients, Magerl screw breakage in one patient, cervical pedicle screw fracture in two patients, and disassembly of the pedicle screw and rod in two patients (one with an occipital plate fracture). There was no rod fracture. The implant failures were asymptomatic, except in one patient. Disassembly of the pedicle screw and rod was observed immediately after another surgical procedure under general anesthesia in two patients. Conclusions The failure rate of 4.2% was similar to the rates reported in the literature for posterior lumbar spinal fusion, confirming the reliability of the recent cervical screw-rod system.

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Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 59%

Section: The Characteristics As For Cervical Instrumentation Failurementioning

confidence: 99%

Mechanical implant failure in posterior cervical spine fusion

et al. 2011

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“…Additionally, 14 cases required anterior spine fusion. A mean of 12.2 segments were fused (range [8][9][10][11][12][13][14][15][16][17]. The mean cephalic level of instrumentation was T3.8 (T1, 5 cases; T2, 21; T3, 20; T4, 45; T5, 30; T6, 6; T7, 5; and T8, 1).…”

Section: Methodsmentioning

confidence: 99%

“…McAfee et al [17] published a survivorship analysis of 526 pedicular screws (Cotrel-Dubousset and VSP-Steffee) used for the treatment of various degenerative conditions of the spine. In a work on VSP-Steffee instrumentation in vertebral fractures, Ebelke et al [11] compared survival curves to determine the advantage of using an anterior structural graft in association with posterior osteosynthesis.…”

mentioning

confidence: 99%

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Bagó¹,

Valencia²,

Pellisé³

et al. 2003

European Spine Journal

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IntroductionThe outcome of treatment for idiopathic scoliosis is usually assessed by radiologic study, to determine the angular correction obtained, and by analysis of the clinical results. Another datum of interest, particularly regarding vertebral implants, is the incidence of reoperations. From the patient's viewpoint, an implant that achieves excellent correction but is very likely to require a second operation may not be considered satisfactory. The appropriate statistical method for evaluating this event is survivorship analysis, which allows one to determine the true reoperation rate and to predict the probability of reoperation in the long Abstract This study presents a survivorship analysis of Cotrel-Dubousset instrumentation in the surgical treatment of idiopathic scoliosis. Between 1987 and 1995, a total of 133 patients with idiopathic scoliosis received posterior spine fusion and instrumentation with the CD system at our center. The patients' mean age at surgery was 16.5 years (range 11-43 years). The magnitude of the thoracic scoliosis averaged 62.7°(range 40°-125°) and that of the lumbar curve was 58.8°(range 40°-100°). On average, 12.2 segments were fused (range 8-17) and, excluding the rods, 14.1 implants were set for each patient (range 10-21). Survivorship analysis was carried out using the Kaplan-Meier method. Implant removal was considered the terminal event, or "death". The effect of several variables on survival rate was determined with the Cox regression method. The patients remained in the study for 56.7 months (range 2-120 months). One-hundred and ten patients were withdrawn ("censored"): 90 "alive" (did not require repeat surgery and attended followup control in 1997) and 20 "lost" (did not attend control in 1997). Twenty-three patients attained the terminal event of implant removal for a variety of reasons: acute infection (three cases), late infection (ten cases), implant failure requiring revision (six cases) and local pain (four cases). The survival rate was 95.5% at 3 months, 94.7% at 6 months, 93.9% at 1 year, 91.5% at 2 years, 82.2% at 5 years and 76.5% at 10 years. The magnitude of the curves, total number of implants and number of fused segments did not correlate with survival probability. A positive correlation was found between survival rate and correction loss between surgery and last control. A survival rate of 76.5% at 10 years is unexpectedly low. Current data suggest that the incapacity to maintain correction after initial surgery plays a major roll in the long-term evolution of CotrelDubousset instrumentation.

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“…The effect of constrained (rigid) systems in the lumbar spine has already been evaluated [7,34,50], whereas studies for the cervical spine are rare. The higher stability of pedicle screws in comparison with lateral mass screws [26,27] led to a frequent use in the lumbar spine [1,4,5,6,23,32,35] for various spinal disorders, including spondylolisthesis, scoliosis or degenerative conditions, and to a lesser degree in the cervical spine [2,3]. Acceptable complication rates were observed [18,57].…”

Section: Introductionmentioning

confidence: 99%

Effect of constrained posterior screw and rod systems for primary stability: Biomechanical in vitro comparison of various instrumentations in a single-level corpectomy model

et al. 2004

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Cervical corpectomy is a frequently used technique for a wide variety of spinal disorders. The most commonly used approach is anterior, either with or without plating. The results for single-level corpectomy are better than in multilevel procedures. Nevertheless, hardwareor graft-related complications are observed. In the past, constrained implant systems were developed and showed encouraging stability, especially for posterior screw and rod systems in the lumbar spine. In the cervical spine, few reports about the primary stability of constrained systems exist. Therefore, in the present study we evaluated the primary stability of posterior screw and rod systems, constrained and non-constrained, in comparison with anterior plating and circumferential instrumentations in a non-destructive set-up, by loading six human cadaver cervical spines with pure moments in a spine tester. Range of motion and neutral zone were measured for lateral bending, flexion/ extension and axial rotation.

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Survivorship Analysis of Pedicle Spinal Instrumentation

Cited by 94 publications

References 0 publications

Mechanical implant failure in posterior cervical spine fusion

Mechanical implant failure in posterior cervical spine fusion

Survivorship analysis of Cotrel-Dubousset instrumentation in idiopathic scoliosis

Effect of constrained posterior screw and rod systems for primary stability: Biomechanical in vitro comparison of various instrumentations in a single-level corpectomy model

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