J Korean Neurosurg Soc.  2018 May;61(3):415-423. 10.3340/jkns.2017.0505.002.

Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine

Affiliations
  • 1Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 2Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
  • 3Department of Biostatistics, Seoul National University Boramae Medical Center, Seoul, Korea.
  • 4Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. chungc@snu.ac.kr
  • 5Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
  • 6Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea.
  • 7Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea.

Abstract


OBJECTIVE
To identify the perioperative factors associated with instrument failure in patients undergoing a partial corpectomy with instrumentation (PCI) for spinal metastasis.
METHODS
We assessed the one hundred twenty-four patients with who underwent PCI for a metastatic spine from 1987 to 2011. Outcome measure was the risk factor related to implantation failure. The preoperative factors analyzed were age, sex, ambulation, American Spinal Injury Association grade, bone mineral density, use of steroid, primary tumor site, number of vertebrae with metastasis, extra-bone metastasis, preoperative adjuvant chemotherapy, and preoperative spinal radiotherapy. The intraoperative factors were the number of fixed vertebrae, fixation in osteolytic vertebrae, bone grafting, and type of surgical approach. The postoperative factors included postoperative adjuvant chemotherapy and spinal radiotherapy. This study was supported by the National Research Foundation grant funded by government. There were no study-specific biases related to conflicts of interest.
RESULTS
There were 15 instrumentation failures (15/124, 12.1%). Preoperative ambulatory status and primary tumor site were not significantly related to the development of implant failure. There were no significant associations between insertion of a bone graft into the partial corpectomy site and instrumentation failure. The preoperative and operative factors analyzed were not significantly related to instrumentation failure. In univariable and multivariable analyses, postoperative spinal radiotherapy was the only significant variable related to instrumentation failure (p=0.049 and 0.050, respectively).
CONCLUSION
When performing PCI in patients with spinal metastasis followed by postoperative spinal radiotherapy, the surgeon may consider the possibility of instrumentation failure and find other strategies for augmentation than the use of a bone graft for fusion.

Keyword

Spine; Metastasis; Decompression; Radiotherapy

MeSH Terms

Bias (Epidemiology)
Bone Density
Bone Transplantation
Chemotherapy, Adjuvant
Decompression
Financial Management
Financing, Organized
Humans
Neoplasm Metastasis
Outcome Assessment (Health Care)
Radiotherapy
Risk Factors
Spinal Injuries
Spine*
Transplants
Walking

Figure

  • Fig. 1. Plain X-rays show examples of instrumentation failure such as (A and D) instrumentationdisplacement including a methylmethacrylate strut in a patient with hepatocellular carcinoma and metastasis in the cervical spine and (E and H) instrumentationdisplacement in a patient with esophageal carcinoma and metastasis in the lumbar spine. A : Preoperative plain X-ray. B : Immediate postoperative plain X-ray. C : Plain X-ray on the second day after surgery. D : Plain X-ray after revision surgery. We performed additional fixation at c7. E : Preoperative plain X-ray. F : Immediate postoperative plain X-ray. G : Plain X-ray on the 295th day after surgery. H : Plain X-ray after revision surgery. We performed the additional posterior fixation.


Reference

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