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.

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.

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.

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

Total en bloc spondylectomy for spinal tumours: Technical aspects and surgical details

2017 ◽  
Vol 28 (2) ◽  
pp. 51-66 ◽  
Author(s):  
Pedro David Delgado-López ◽  
Antonio Rodríguez-Salazar ◽  
Vicente Martín-Velasco ◽  
José Manuel Castilla-Díez ◽  
Javier Martín-Alonso ◽  
...  
Keyword(s):  
Spinal Tumours ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
Technical Aspects ◽  
En Bloc Spondylectomy ◽  
Bloc Spondylectomy

scholarly journals Electrophysiological monitoring during preoperative angiography to guide decisions regarding permanent occlusion of major radicular arteries in patients undergoing total en bloc spondylectomy

2016 ◽  
Vol 41 (2) ◽  
pp. E19 ◽  
Author(s):  
Khalil Salame ◽  
Shimon Maimon ◽  
Gilad J. Regev ◽  
Tali Jonas Kimchi ◽  
Akiva Korn ◽  
...  
Keyword(s):  
Evoked Potential ◽  
Case Series ◽  
En Bloc ◽  
Total En Bloc Spondylectomy ◽  
En Bloc Spondylectomy ◽  
Spine Tumors ◽  
Electrophysiological Monitoring ◽  
Case Series Study ◽  
Bloc Spondylectomy ◽  
Temporary Occlusion

OBJECTIVE Preoperative embolization is performed before spine tumor surgery when significant intraoperative hemorrhage is anticipated. Occlusion of radicular and segmental arteries may result in spinal ischemia. The goal of this study was to check whether neurophysiological monitoring during preoperative angiography in patients scheduled for total en bloc spondylectomy (TES) of spine tumors improves the safety of vessel occlusion. METHODS This was a case series study of patients who underwent tumor embolization under somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring in preparation for TES in treating spine tumors. The angiography findings, the embolized vessels, and the results are presented. RESULTS Five patients whose ages ranged from 33 to 75 years and who had thoracic spine tumors are reported. Four patients suffered from primary tumor and 1 patient had a metastatic tumor. Radicular arteries at the tumor level, 1 level above, and 1 level below were permanently occluded when SSEPs and MEPs were preserved during temporary occlusion. No complications were encountered during or after the angiography procedure and embolization. CONCLUSIONS Temporary occlusion with electrophysiological monitoring during preoperative angiography may improve the safety of permanent radicular artery occlusion, including the artery of Adamkiewicz in patients undergoing TES for the treatment of spine tumors.

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.

scholarly journals Revision of 116 orthognathic surgery patients operated on with the high-oblique sagittal osteotomy (HOSO): a retrospective case series (PROCESS-compliant article)

2020 ◽  
Author(s):  
C. Herrera-Vizcaino ◽  
L. Seifert ◽  
M. Berdan ◽  
S. Ghanaati ◽  
M. Klos ◽  
...  
Keyword(s):  
Complication Rate ◽  
Orthognathic Surgery ◽  
Mouth Opening ◽  
Case Series ◽  
Operation Time ◽  
University Hospital ◽  
Material Failure ◽  
Retrospective Case ◽  
Non Union ◽  
Facial Plastic

Abstract Background The high-oblique sagittal osteotomy (HOSO) is an alternative to a bilateral sagittal split osteotomy (BSSO). Due to its novelty, there are no long-term studies which have focused on describing the incidence and type of complications encountered in the post-operative follow-up. The aim of this retrospective study is to analyze patients operated on with this surgical technique and the post-operative complications encountered. Patient and methods The electronic medical records of all patients treated with orthognathic surgery at the Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany, between the years 2009 and 2016 were retrospectively reviewed. Results A total of 116 patients fulfilled the inclusion criteria. The cases operated on with the standard osteosynthesis (X, Y, and straight) showed a complication rate of 36.37% (n = 4/11). The cases operated on with the HOSO-dedicated plates (HOSO-DP) showed, in total, a complication rate of 6.67% (n = 7/105). The most common post-operative complication resulting from both fixation methods was a reduction in mouth opening and TMJ pain for 4.3%. During the first years of performing the surgery (2009–211), a variety of standard plates had material failure causing non-union or pseudarthrosis. No cases of material failure were observed in the cases operated on with the HOSO-DP. The statistical results showed a highly significant dependence of a reduction in OP-time over the years, when the HOSO was performed without additional procedures (R2 > 0.83, P < 0.0015). Conclusion The rate of complications in the HOSO were shown to be comparable to the rate of complications from the BSSO reported in the literature. Moreover, the use of the ramus dedicated plate appears to provide enough stability to the bone segments, making the surgery safer. Clinical relevance The HOSO needs to be considered by surgeons as an alternative to BSSO. Once the use of the HOSO-DP was established, the rate of complications and the operation time reduced considerably.

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