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Revision strategies for salvaging or improving failed cylindrical cages
P C McAfee1, B W Cunningham, G A Lee
1Scoliosis and Spine Center, Union Memorial Hospital Baltimore, Maryland, USA.
Spine
|October 30, 1999
Summary
Surgical technique, not device flaws, caused interbody fusion cage failures. Proper surgical technique is crucial for successful spinal fusion and to prevent complications with threaded fusion cages.
Area of Science:
- Spine surgery
- Orthopedic surgery
- Biomaterials in orthopedics
Background:
- Postoperative management of failed interbody fusion devices is not well-described.
- Intraoperative complications of spinal fusion devices have been previously reported.
Purpose of the Study:
- To review the causes of failure in cylindrical interbody fusion cages.
- To explore potential treatment strategies for failed cages.
Main Methods:
- Retrospective review of 20 patients with failed threaded titanium fusion cages (Bagby and Kuslich Devices, Ray Threaded Fusion Cages).
- Analysis of revision surgery procedures and histopathological examination of 14 explanted devices.
- Patients underwent revision surgery for failed arthrodesis before successful fusion.
Main Results:
- Average implant duration before revision was 31.8 weeks.
- Common revision procedures included nerve root decompression and foraminotomy.
- Cage migration into the spinal canal occurred in four cases requiring removal.
Conclusions:
- All cage failures were attributed to surgical technique errors, not inherent device defects.
- Factors contributing to failure include inadequate distraction, undersized cages, and improper graft material selection.
- Surgical technique during cage insertion significantly impacts spinal fusion outcomes.