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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Symptomatic Construct Failure after Metastatic Spine Tumor Surgery.

Naresh Kumar1, Ravish Patel1, Jiong Hao Tan1

  • 1Department of Orthopaedic Surgery, National University Health System, Singapore.

Asian Spine Journal
|October 28, 2020
PubMed
Summary

Symptomatic failures (SFs) after metastatic spine tumor surgery (MSTS) occurred in 5.7% of patients, with most failures happening at the implant-bone interface. Preoperative factors like the Eastern Cooperative Oncology Group score significantly increased the risk of failure.

Keywords:
Implant failureImplants, ArtificialNeoplasm metastasisSpineSurgery

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Area of Science:

  • Spine surgery
  • Oncology
  • Orthopedics

Background:

  • Metastatic spine tumor surgery (MSTS) aims to improve quality of life, but symptomatic failures (SFs) can occur.
  • Previous studies report a wide incidence range (1.9%-16%) of SFs after MSTS, with limited understanding of risk factors and management.
  • It remains unclear if all SFs necessitate revision surgery.

Purpose of the Study:

  • To determine the incidence and presentation of symptomatic failures (SFs) following metastatic spine tumor surgery (MSTS).
  • To identify risk factors associated with SFs in MSTS patients.
  • To classify SFs based on their management strategies.

Main Methods:

  • A retrospective analysis of 288 patients (246 for final analysis) who underwent MSTS between 2005 and 2015.
  • Data included demographics and clinical/radiological features. Early (<3 months) and late (≥3 months) radiological SFs were defined.
  • Competing risk regression models were used to identify risk factors for SF, with death as a competing event.

Main Results:

  • The incidence of SF was 5.7% (14/246 patients), with 4.1% (10/246) requiring revision surgery.
  • SFs were categorized into implant revision (35.7%), disease progression (35.7%), and those not requiring revision (28.5%).
  • Preoperative Eastern Cooperative Oncology Group performance status was a significant risk factor for implant failure (aSHR=7.0, p<0.0009).

Conclusions:

  • The incidence of SF after MSTS was low (5.7%), even without spinal fusion.
  • Preoperative factors such as being an ambulator, a Spinal Instability Neoplastic Score (SINS) >7, and fixation spanning junctional regions were associated with SF.
  • The majority of construct failures occurred at the implant-bone interface.