Journal article
Basic concepts in metal work failure after metastatic spine tumour surgery.
- Kumar N Department of Orthopaedic Surgery, National University Hospital, Singapore, 119074, Singapore. dosksn@nus.edu.sg.
- Patel R Department of Orthopaedic Surgery, National University Hospital, Singapore, 119074, Singapore.
- Wadhwa AC Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, 768824, Singapore.
- Kumar A Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, Singapore, 768824, Singapore.
- Milavec HM Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
- Sonawane D Department of Orthopaedic Surgery, National University Hospital, Singapore, 119074, Singapore.
- Singh G Department of Orthopaedic Surgery, National University Hospital, Singapore, 119074, Singapore.
- Benneker LM Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
- 2017-12-06
Published in:
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. - 2018
Asymptomatic implant failure
Early failure
Late failure
Metastatic spine tumour surgery
Symptomatic implant failure
Decompression, Surgical
Humans
Metals
Prostheses and Implants
Prosthesis Failure
Spinal Neoplasms
Spine
English
PURPOSE
The development of spinal implants marks a watershed in the evolution of metastatic spine tumour surgery (MSTS), which has evolved from standalone decompressive laminectomy to instrumented stabilization and decompression with reconstruction when necessary. Fusion may not be feasible after MSTS due to poor quality of graft host bed along with adjunct chemotherapy and/or radiotherapy postoperatively. With an increase in the survival of patients with spinal tumours, there is a probability of an increase in the rate of implant failure. This review aims to help establish a clear understanding of implants/constructs used in MSTS and to highlight the fundamental biomechanics of implant/construct failures.
METHODS
Published literature on implant failure after spine surgery and MSTS has been reviewed. The evolution of spinal implants and their role in MSTS has been briefly described. The review defines implant/construct failures using radiological parameters that are practical, feasible, and derived from historical descriptions. We have discussed common modes of implant/construct failure after MSTS to allow further understanding, interception, and prevention of catastrophic failure.
RESULTS
Implant failure rates in MSTS are in the range of 2-8%. Variability in patterns of failure has been observed based on anatomical region and the type of constructs used. Patients with construct/implant failures may or may not be symptomatic and present either as early (< 3months) or late failures (> 3months). It has been noted that not all the implant failures after MSTS result in revisions.
CONCLUSION
Based on the observed radiological criteria and clinical presentations, we have proposed a clinico-radiological classification for implant/construct failure after MSTS.
The development of spinal implants marks a watershed in the evolution of metastatic spine tumour surgery (MSTS), which has evolved from standalone decompressive laminectomy to instrumented stabilization and decompression with reconstruction when necessary. Fusion may not be feasible after MSTS due to poor quality of graft host bed along with adjunct chemotherapy and/or radiotherapy postoperatively. With an increase in the survival of patients with spinal tumours, there is a probability of an increase in the rate of implant failure. This review aims to help establish a clear understanding of implants/constructs used in MSTS and to highlight the fundamental biomechanics of implant/construct failures.
METHODS
Published literature on implant failure after spine surgery and MSTS has been reviewed. The evolution of spinal implants and their role in MSTS has been briefly described. The review defines implant/construct failures using radiological parameters that are practical, feasible, and derived from historical descriptions. We have discussed common modes of implant/construct failure after MSTS to allow further understanding, interception, and prevention of catastrophic failure.
RESULTS
Implant failure rates in MSTS are in the range of 2-8%. Variability in patterns of failure has been observed based on anatomical region and the type of constructs used. Patients with construct/implant failures may or may not be symptomatic and present either as early (< 3months) or late failures (> 3months). It has been noted that not all the implant failures after MSTS result in revisions.
CONCLUSION
Based on the observed radiological criteria and clinical presentations, we have proposed a clinico-radiological classification for implant/construct failure after MSTS.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1007/s00586-017-5405-z
- PMID 29204734
- Persistent URL
- https://sonar.ch/global/documents/178496
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