Risk factors for Implant Failure in Thoracolumbar Fractures Treated with Posterior Long-Segment Instrumentation

Area of Science:

• Spine surgery
• Orthopedic trauma
• Implant biomechanics

Background:

• Posterior long-segment instrumentation (PLSI) is a common surgical technique for thoracolumbar fractures (TLFx).
• High implant failure rates and complications like pain and kyphosis can occur despite PLSI in unstable fractures.
• Limited research exists on PLSI implant failure rates and associated risk factors in TLFx.

Purpose of the Study:

• To determine the implant failure rate associated with PLSI in patients with TLFx.
• To identify demographic, injury-related, and surgical risk factors for implant failure following PLSI for TLFx.

Main Methods:

• Retrospective review of 162 consecutive TLFx patients treated with PLSI (follow-up > 1 year).
• Implant failure defined as rod breakage, cap dislodgement, or screw breakage.
• Multivariate regression analysis to evaluate risk factors for implant failure.

Main Results:

• Implant failure occurred in 9.3% of patients (15 cases) over a mean follow-up of 28 months.
• Significant risk factors for implant failure included current smoking, mid to low lumbar fracture level, and anterior compression ratio (ACR).
• Multivariate analysis identified smoking (aOR 5.924), lumbar fracture (aOR 15.977), and ACR (aOR 1.061) as predictors.

Conclusions:

• PLSI for TLFx demonstrates a notable implant failure rate.
• Current smoking, fracture location in the mid to low lumbar spine, and higher ACR are significant predictors of implant failure.
• Identifying these risk factors can aid in surgical decision-making and optimizing patient outcomes for TLFx.