Abstract
BackgroundThere have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; however, clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported. Therefore, this study assessed the clinical outcomes of revision surgery for instrumentation failure after TES.MethodsThis study employed a retrospective case series in a single center and included 61 patients with spinal tumors who underwent TES between 2010 and 2015 and were followed up for > 2 years. Instrumentation failure rate, back pain, neurological deterioration, ambulatory status, operation time, blood loss, complications, bone fusion after revision surgery, and re-instrumentation failure were assessed. Data were collected on back pain, neurological deterioration, ambulatory status, and management for patients with instrumentation failure, and we documented radiological bone fusion and re-instrumentation failure in cases followed up for > 2 years after revision surgery.ResultsOf the 61 patients, 26 (42.6%) experienced instrumentation failure at an average of 32 (range, 11–92) months after TES. Of these, 23 underwent revision surgery. The average operation time and intraoperative blood loss were 204 min and 97 ml, respectively. Including the six patients who were unable to walk after instrumentation failure, all patients were able to walk after revision surgery. Perioperative complications of reoperation were surgical site infection (n = 2) and delayed wound healing (n = 1). At the final follow-up, bone fusion was observed in all patients. No re-instrumentation failure was recorded.ConclusionBone fusion was achieved by revision surgery using the posterior approach alone.
Highlights
There have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported
Revision surgery was performed with posterior instrumentation replacement in all 23 patients, posterior bone grafting in 21 patients, and additional bone grafting around the cage in three patients
Intraoperative findings via a posterior approach did not reveal any obvious pseudoarthroses in the patients because the scar tissue covered the anterior column where the pseudoarthroses existed, but mild metallosis at the rod fracture site was observed in nine patients
Summary
There have been several reports of instrumentation failure after three-column resections such as total en bloc spondylectomy (TES) for spinal tumors; clinical outcomes of revision surgery for instrumentation failure after TES are seldom reported. This study assessed the clinical outcomes of revision surgery for instrumentation failure after TES. Total en bloc spondylectomy (TES) was developed for complete surgical resection for spinal tumors [1, 2]. To restore spinal stability after resection, robust instrumentation and bone grafting are needed, with anterior column support [10,11,12]. Failure of bone fusion can cause instrumentation failure, causing back pain, neurological deterioration, and decreased performance of activities of daily living (ADL) [13,14,15,16,17,18]. Revision surgery is required to improve spinal stability and symptoms
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