Revision strategy and follow-up for implant failure in a case of combined anterior and posterior reconstruction after three-level en bloc vertebral body replacement and replacement of the aorta for chondrosarcoma of the thoracic spine

2018 ◽  
Vol 28 (S2) ◽  
pp. 13-17 ◽  
Author(s):  
T. Graulich ◽  
C. Krettek ◽  
C. W. Müller
Keyword(s):  
Vertebral Body ◽  
Thoracic Spine ◽  
Implant Failure ◽  
Vertebral Body Replacement ◽  
En Bloc ◽  
Posterior Reconstruction

Monostotic fibrous dysplasia of the thoracic spine: clinopathological description and follow up

2004 ◽  
Vol 100 (4) ◽  
pp. 378-381 ◽  
Author(s):  
Mehmet Arazi ◽  
Onder Guney ◽  
Mustafa Ozdemir ◽  
Omer Uluoglu ◽  
Nuket Uzum
Keyword(s):  
Fibrous Dysplasia ◽  
Thoracic Spine ◽  
Histopathological Examination ◽  
En Bloc Resection ◽  
Spinal Tumors ◽  
En Bloc ◽  
Content Type ◽  
Thoracic Spinal ◽  
Fine Print

✓ The authors report the case of a 53-year-old woman with monostotic fibrous dysplasia of the thoracic spine. The patient presented with a 1-month history of pain in the thoracic spinal region. En bloc resection of the lesion was successfully performed via a transthoracic approach, and a histopathological examination confirmed the diagnosis of fibrous dysplasia. At 24-month follow-up examination, pain and vertebral instability were absent. The findings in this case illustrate that, although very rare, monostotic fibrous dysplasia of the thoracic spine should be considered in the differential diagnosis of spinal tumors. Although a consensus for management of this disease has not been achieved, the authors recommend radical removal of all involved bone as well as internal fixation or bone graft—assisted fusion to achieve long-term stabilization.

scholarly journals Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

2020 ◽  
Vol 8 (B) ◽  
pp. 76-80
Author(s):  
Moneer K. Faraj ◽  
Bassam Mahmood Flamerz  Arkawazi ◽  
Hazim Moojid Abbas ◽  
Zaid Al-Attar
Keyword(s):  
Functional Outcome ◽  
Vertebral Body ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Spinal Tuberculosis ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Karnofsky Performance Status Scale ◽  
Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

scholarly journals Vertebral body replacement with an expandable cage for reconstruction after spinal tumor resection

2003 ◽  
Vol 15 (5) ◽  
pp. 1-6 ◽  
Author(s):  
Issada Thongtrangan ◽  
Raju S. V. Balabhadra ◽  
Hoang Le ◽  
Jon Park ◽  
Daniel H. Kim
Keyword(s):  
Vertebral Body ◽  
Tumor Resection ◽  
Anterior Column ◽  
Vertebral Body Replacement ◽  
Spinal Tumors ◽  
Wide Resection ◽  
Primary Tumors ◽  
Expandable Cage ◽  
Expandable Cages

Object The authors report their clinical experience with expandable cages used to stabilize the spine after verte-brectomy. The objectives of surgical treatment for spine tumors include a decrease in pain, decompression of the neural elements, mechanical stabilization of the spine, and wide resection to gain local control of certain primary tumors. Most of the lesions occur in the anterior column or vertebral body (VB). Anterior column defects following resection of VBs require surgical restoration of anterior column support. Recently, various expandable cages have been developed and used clinically for VB replacement (VBR). Methods Between January 2001 and June 2003, the authors treated 15 patients who presented with primary spinal tumors and metastatic lesions from remote sites. All patients underwent vertebrectomy, VBR with an expandable cage, and anterior instrumentation with or without posterior instrumentation, depending on the stability of the involved segment. The correction of kyphotic angle was achieved at an average of 20°. Pain scores according to the visual analog scale decreased from 8.4 to 5.2 at the last follow-up review. Patients whose Frankel neurological grade was below D attained at least a one-grade improvement after surgery. All patients achieved immediate stability postsurgery and there were no significant complications related to the expandable cage. Conclusions The advantage of the expandable cage is that it is easy to use because it permits optimal fit and correction of the deformity by in vivo expansion of the device. These results are promising, but long-term follow up is required.

Oncosurgical Results of Multilevel Thoracolumbar En-bloc Spondylectomy and Reconstruction with a Carbon Composite Vertebral Body Replacement System

Spine ◽  
2011 ◽  
Vol 36 (10) ◽  
pp. E647-E655 ◽  
Author(s):  
Alexander Carl Disch ◽  
Klaus-Dieter Schaser ◽  
Ingo Melcher ◽  
Franco Feraboli ◽  
Werner Schmoelz ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Carbon Composite ◽  
Vertebral Body Replacement ◽  
En Bloc ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Replacement System

scholarly journals Dorsal instrumentation with and without vertebral body replacement in patients with thoracolumbar osteoporotic fractures shows comparable outcome measures

2021 ◽  
Author(s):  
Maximilian Schwendner ◽  
Stefan Motov ◽  
Yu-Mi Ryang ◽  
Bernhard Meyer ◽  
Sandro M. Krieg
Keyword(s):  
Vertebral Body ◽  
Thoracolumbar Spine ◽  
Osteoporotic Fractures ◽  
The Elderly ◽  
Vertebral Body Replacement ◽  
Inclusion Criteria ◽  
Dorsal Instrumentation ◽  
The Individual

Abstract Purpose In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. Methods A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. Results Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994). Conclusion 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.

Cranioplasty, Vertebral Body Replacement, and Spinal Fusion with Tobramycin-impregnated Methylmethacrylate

Neurosurgery ◽  
1991 ◽  
Vol 28 (6) ◽  
pp. 789-791 ◽  
Author(s):  
Scott A. Shapiro
Keyword(s):  
Spinal Fusion ◽  
Blood Urea Nitrogen ◽  
Vertebral Body ◽  
Vertebral Body Replacement ◽  
Time Interval ◽  
Prospective Analysis ◽  
Local Infection ◽  
Normal Limits ◽  
Previously Treated

Abstract A prospective analysis of cranioplasty, vertebral body replacement, and spinal fusion using tobramycin-impregnated methylmethacrylate in 65 patients is presented. Cranioplastic methacrylate (1 packet) was mixed with 1.2 g of powdered tobramycin and placed into the desired location. The polymer was irrigated with bacitracin until it became solid. All patients received prophylactic medication with intravenously administered nafcillin and cephalosporin perioperatively and for 48 hours postoperatively. The follow-up time ranged from 7 to 57 months (mean, 32.2 months). Serum tobramycin levels remained below 0.5 μg/ml in all patients tested, regardless of the time interval. Blood urea nitrogen and creatinine levels remained within normal limits in all patients, and there has been no nephrotoxicity or ototoxicity. There has been 1 infection among the 65 patients (1%) to date. It occurred in a patient who had a previously treated local infection. Cranioplasty, vertebral body replacement, or spinal fusion with tobramycin-impregnated methylmethacrylate is safe and may reduce the incidence of infection.

Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation

2020 ◽  
Vol 20 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Natan Yusupov ◽  
Sebastian Siller ◽  
Johann Hofereiter ◽  
Heinrich Karl Boehm ◽  
Manuel Fuetsch ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Sagittal Profile ◽  
Vertebral Body Replacement ◽  
Radiological Evaluation ◽  
Titanium Cage ◽  
Single Level ◽  
Anterior Corpectomy ◽  
Expandable Titanium Cage

Abstract BACKGROUND Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. OBJECTIVE To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. METHODS Between 2011 and 2017, 40 patients underwent a single-level (N = 32) or 2-level (N = 8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. RESULTS Mean last follow-up was 14.8 ± 7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (>1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. CONCLUSION Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.

scholarly journals Short term radiological outcome of inserting screw at fracture level in posterior short segment fixation in thoracolumbar burst fractures

2017 ◽  
Vol 4 (3) ◽  
pp. 71-76
Author(s):  
Rabindra Lal Pradhan ◽  
Bimal Kumar Pandey ◽  
Krishna Raj Khanal
Keyword(s):  
Vertebral Body ◽  
Body Height ◽  
Fracture Site ◽  
Implant Failure ◽  
Vertebral Body Height ◽  
Short Segment ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
Short Segment Fixation

Background: Unstable thoracolumbar burst fractures are treated surgically by short segment fixation but may be associated with high implant failure. Supplementation of anterior column by insertion of screw at fracture site makes it more biomechanically stable.Objectives: The purpose of this prospective study was to evaluate radiological parameters in thoracolumbar fractures treated with intermediate screw fixation with a minimum follow up of two years.Methods: This prospective study was conducted from 2011 till 2012 where unstable  thoracolumbar fractures treated with short segment posterior instrumentation with screw at fracture site were evaluated. All patients (average age 34.64 were followed up for at least 24 months and were classified according to Thoracolumbar Injury Classification and Severity Score and load sharing classifi cation. Out of total 32 patients, four lost to follow up. Radiological parameters like vertebral body height and segmental kyphosis were evaluated and pain was evaluated by Visual Analogue Scale score.Results: Preoperative pain showed mean Visual Analogue Scale Score score of 8.29 that improved to 0.97 at fi nal follow up. Average preoperative loss of vertebral body height was 48.19 %, which improved to 11.4 % after surgery (p<.001). Final vertebral body collapse was 12.98 % with mean percentage loss of vertebral height at 1.57%. Average segmental kyphotic angle was 22.54 before surgery, which corrected to 5.89 immediately after surgery (p<0.001). Final segmental kyphosis was 8.46. Loss of kyphosis correction was 2.57. Two patients had implant failure, but was solidly united during implant removal in both cases.Conclusion: Excellent maintenance of reduction in thoracolumbar burst fractures with short segment fixation with intermediate screws at fracture site with limited decompression resulted in improved neurologic function and satisfactory clinical outcomes, with a low incidence of implant failure and progressive deformity.

In vitro comparison of personalized 3D printed versus standard expandable titanium vertebral body replacement implants in the mid-thoracic spine using entire rib cage specimens

2020 ◽  
Vol 78 ◽  
pp. 105070
Author(s):  
Christian Liebsch ◽  
Viktor Aleinikov ◽  
Talgat Kerimbayev ◽  
Serik Akshulakov ◽  
Tugrul Kocak ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Thoracic Spine ◽  
Vertebral Body Replacement ◽  
Rib Cage ◽  
3D Printed ◽  
In Vitro Comparison
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