Asian Spine J.  2020 Dec;14(6):878-885. 10.31616/asj.2020.0034.

Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Affiliations
  • 1Department of Orthopedics and Traumatology, Prince of Wales Hospital, Hong Kong SAR, China
  • 2Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China

Abstract

Study Design: Retrospective study. Purpose: To investigate the incidence of symptomatic and asymptomatic implant failure in spinal metastasis surgery and identify potential risk factors. Overview of Literature: Surgical stabilization with instrumentation is an established method for the treatment of spinal metastasis. However, very few studies have investigated the incidence and risk factors for implant failure after spinal instrumentation surgery for the treatment of spinal metastasis.
Methods
This study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors.
Results
Implant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure.
Conclusions
The development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

Keyword

Neoplasm metastasis; Spine; Radiotherapy; Reoperation
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