Risk Factors for Instrumentation Failure After Total En Bloc Spondylectomy of Thoracic and Lumbar Spine Tumors Using Titanium Mesh Cage for Anterior Reconstruction

2020 ◽  
Vol 135 ◽  
pp. e106-e115 ◽  
Author(s):  
Zhehuang Li ◽  
Feng Wei ◽  
Zhongjun Liu ◽  
Xiaoguang Liu ◽  
Liang Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Titanium Mesh ◽  
Titanium Mesh Cage ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Thoracic And Lumbar Spine ◽  
Mesh Cage ◽  
Instrumentation Failure ◽  
Anterior Reconstruction

scholarly journals The most appropriate titanium mesh cage size for anterior spinal reconstruction after single-level lumbar total en bloc spondylectomy: a finite element analysis and cadaveric validation study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Permsak Paholpak ◽  
Winai Sirichativapee ◽  
Taweechok Wisanuyotin ◽  
Weerachai Kosuwon ◽  
Yuichi Kasai ◽  
...  
Keyword(s):  
Finite Element ◽  
Validation Study ◽  
Maximum Stress ◽  
Element Model ◽  
Titanium Mesh ◽  
Titanium Mesh Cage ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Mesh Cage

Abstract Purpose There is little information available regarding the cage diameter that can provide the most rigid construct reconstruction after total en bloc spondylectomy (TES). The aim of this study was thus to determine the most appropriate titanium mesh cage diameter for reconstruction after spondylectomy. Methods A finite element model of the single level lumbar TES was created. Six models of titanium mesh cage with diameters of 1/3, 1/2, 2/3, 3/4, 4/5 of the caudad adjacent vertebra, and 1/1 of the cephalad vertebra were tested for construct stiffness. The peak von Mises stress (MPa) at the failure point and the site of failure were measured as outcomes. A cadaveric validation study also conducted to validate the finite element model. Results For axial loading, the maximum stress points were at the titanium mesh cage, with maximum stress of 44,598 MPa, 23,505 MPa, 23,778 MPa, and 16,598 MPa, 10,172 MPa, 10,805 MPa in the 1/3, 1/2, 2/3, 3/4, 4/5, and 1/1 diameter model, respectively. For torsional load, the maximum stress point in each of the cages was identified at the rod area of the spondylectomy site, with maximum stress of 390.9 MPa (failed at 4459 cycles), 141.35 MPa, 70.098 MPa, and 88.972 MPa, 42.249 MPa, 15.827 MPa, respectively. A cadaveric validation study results were coincided with the finite element model results. Conclusion The most appropriate mesh cage diameter for reconstruction is 1/1 the diameter of the lower endplate of the adjacent cephalad vertebra, due to its ability to withstand both axial and torsional stress. According to the difficulty of large size cage insertion, a cage diameter of more than half of the upper endplate of the caudad vertebrae is acceptable in term of withstand stress. A cage diameter of 1/3 is unacceptable for reconstruction after total en bloc spondylectomy.

scholarly journals Risk factors of instrumentation failure after multilevel total en bloc spondylectomy

2017 ◽  
Vol 1 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Katsuhito Yoshioka ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Noriaki Yokogawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Instrumentation Failure

Risk factors for poor outcomes of early rehabilitation after total en bloc spondylectomy: a retrospective chart review of 140 patients

Spinal Cord ◽  
2020 ◽  
Vol 58 (8) ◽  
pp. 900-907
Author(s):  
Yuki Kurokawa ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Noriaki Yokogawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Early Rehabilitation ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Poor Outcomes

Risk factors for local recurrence after total en bloc spondylectomy for metastatic spinal tumors: A retrospective study

2018 ◽  
Vol 23 (3) ◽  
pp. 459-463 ◽  
Author(s):  
Takashi Igarashi ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Katsuhito Yoshioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Local Recurrence ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

scholarly journals Revision surgery for instrumentation failure after total en bloc spondylectomy: a retrospective case series

2020 ◽  
Author(s):  
Kazuya Shinmura ◽  
Satoshi Kato ◽  
Satoru Demura ◽  
Noriaki Yokogawa ◽  
Noritaka Yonezawa ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Case Series ◽  
Operation Time ◽  
Spinal Tumours ◽  
Retrospective Case ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Bone Fusion ◽  
Bloc Spondylectomy ◽  
Instrumentation Failure

Abstract Background: There have been several reports of instrumentation failure after 3-column resections such as total en bloc spondylectomy (TES) for spinal tumours; nevertheless, 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. Methods: This study employed a retrospective case series in a single centre and included 61 patients with spinal tumours who underwent TES between 2010 and 2015 and followed 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 for >2 years after revision surgery. Results: Of 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. Conclusion: Bone fusion was achieved by revision surgery using the posterior approach alone.

Stress of mesh cage using for total en bloc spondylectomy and the surrounding bone remodeling

2000 ◽  
Vol 2000.11 (0) ◽  
pp. 49-50
Author(s):  
Jiro SAKAMOTO ◽  
Juhachi ODA ◽  
Atsushi KAKUUCHI ◽  
Tomoyuki AKAMARU ◽  
Norio KAWAHARA ◽  
...  
Keyword(s):  
Bone Remodeling ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy ◽  
Mesh Cage ◽  
Surrounding Bone

Total cervical spondylectomy for primary osteogenic sarcoma

2002 ◽  
Vol 97 (3) ◽  
pp. 386-392 ◽  
Author(s):  
Zvi R. Cohen ◽  
Daryl R. Fourney ◽  
Rex A. Marco ◽  
Laurence D. Rhines ◽  
Ziya L. Gokaslan
Keyword(s):  
Cervical Spine ◽  
Osteogenic Sarcoma ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Nerve Roots ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Content Type ◽  
Bloc Spondylectomy ◽  
Thoracic And Lumbar Spine

✓ The authors describe a technique for total spondylectomy for lesions involving the cervical spine. The method involves separately staged anterior and posterior approaches and befits the unique anatomy of the cervical spine. The procedure is described in detail, with the aid of radiographs, intraoperative photographs, and illustrations. Unlike in the thoracic and lumbar spine—for which methods of total en bloc spondylectomy have previously been described—a strictly en bloc resection is not possible in the cervical spine because of the need to preserve the vertebral arteries and the nerve roots supplying the upper limbs. Although the resection described in this case is by definition intralesional, it is oncologically sound, given the development of effective neoadjuvent chemotherapeutic regimens for osteosarcoma.

scholarly journals Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

2015 ◽  
Vol 15 (1) ◽  
pp. 132-137 ◽  
Author(s):  
Hiroyuki Hayashi ◽  
Hideki Murakami ◽  
Satoru Demura ◽  
Satoshi Kato ◽  
Katsuhito Yoshioka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Site Infection ◽  
New Technology ◽  
Site Infection ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

Late instrumentation failure after total en bloc spondylectomy

2011 ◽  
Vol 15 (3) ◽  
pp. 320-327 ◽  
Author(s):  
Morio Matsumoto ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
Ken Ishii ◽  
Masaya Nakamura ◽  
...  
Keyword(s):  
Back Pain ◽  
Posterior Approach ◽  
Spinal Tumors ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Spinal Reconstruction ◽  
Bloc Spondylectomy ◽  
Cage Subsidence ◽  
Instrumentation Failure

Object The object of this study was to investigate failures after spinal reconstruction following total en bloc spondylectomy (TES), related factors, and sequelae arising from such failures in patients with malignant spinal tumors. Methods Fifteen patients (12 males and 3 females, with a mean age of 46.5 years) with malignant spinal tumors who underwent TES and survived for more than 1 year were included in this analysis (mean follow-up 41.5 months). Seven patients had primary tumors, including giant cell tumors in 4 patients, chordoma in 2, and Ewing sarcoma in 1. Eight patients had metastatic tumors, including thyroid cancer in 6 and renal cell cancer and malignant fibrous histiocytoma in 1 patient each. Seven patients without prominent paravertebral extension of the tumor were treated using a posterior approach alone, and 8 patients who exhibited prominent anterior or anterolateral extension of the tumors into the thoracic or abdominal cavity were treated using a combined anterior and posterior approach. Spinal reconstruction after tumor resection was performed using a combination of anterior structural support and posterior instrumentation. The relationship between instrumentation failure and clinical and radiographic factors, including age, sex, history of previous surgery, preoperative radiotherapy, tumor histology, tumor level, surgical approach, number of resected vertebrae, rod diameter, number of instrumented vertebrae, and cage subsidence, was investigated. Results Six patients (40%) with spinal instrumentation failure were identified: rod breakage occurred in 3 patients, and breakage of both the rod and the cage, combined cage breakage and screw back-out, and endplate fracture arising from cage subsidence occurred in 1 patient each. All of these patients experienced acute or chronic back pain, but only 1 patient with a tumor recurrence experienced neurological deterioration upon instrumentation failure. Cage subsidence (≥ 5 mm), preoperative irradiation, and the number of instrumented vertebrae (≤ 4 vertebrae) were significantly related to late instrumentation failure. Conclusions Late instrumentation failure was a frequent complication after TES. Although patients with instrumentation failure experienced back pain, the neurological sequelae were not catastrophic. For prevention, meticulous preparation of the graft site and a longer posterior fixation should be considered.

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