Implant Preservation versus Implant Replacement in Revision Surgery for Adjacent Segment Disease After Thoracolumbar Instrumentation: A Retrospective Study of 43 Patients

Abstract

To evaluate the mechanical properties of a new connector rod aiming to preserve implants in revision surgery (RS) for adjacent segment disease, a problematic complication of instrumented spinal fusion, and to assess its clinical applicability. The mechanical properties of the connector-rod construct (implant preservation) and traditional rod construct (implant replacement) were evaluated and compared. Forty-three patients underwent RS for adjacent segment disease in the thoracolumbar spine with implant preservation or replacement, and radiological and clinical outcomes were assessed. Mechanical properties in group A were comparable to those in group B. Total mean time from prior surgery to RS was 6.86 ± 1.08 years. Surgical time and blood loss values of group A were 40.14% and 29.29% statistically significantly smaller than values of group B. In group B, 12% (3/25) of patients developed surgical site infections. In both groups, the visual analog scale leg score decreased significantly after RS. Early postoperative (at 1-month and 3-month follow-up) Oswestry Disability Index and visual analog scale back scores of group A were significantly lower than those of group B; the difference in the visual analog scale back score between groups was significant until the 6-month follow-up. No implant failures occurred, and spinal fusion was achieved in all cases. The connector rod is considered safe and can reduce the surgical time, blood loss, risk of complications, and medical costs. Better early postoperative clinical outcomes can be achieved with the rod owing to less surgical trauma.