Does sagittal alignment after spinal reconstruction following en bloc tumor resection impact revision rate? A...

To investigate if postoperative sagittal alignment in long spinal fusions after lumbar enbloc resections can affect mechanical failure rates in a long-term follow-up study.

Retrospective study. All patients with more than 2-years follow-up, with complete demographic and oncological data, and with a set of standing x-rays that allowed the measure of sagittal spinopelvic parameters, the difference between the ideal and actual postoperative lumbar lordosis (LLM) and the Pelvic Incidence - Lumbar Lordosis mismatch (PI-LL) were included. Data on complications, revision surgery and causes of revision were analyzed.

A total of 31 patients were included. Mechanical failure was observed in 10 patients (31%), and of these, 7 (22.6%) received revision surgery. Higher postoperative LLM (21.7° vs. 10.8°, p < 0.05) and higher PI-LL (15.3° vs. 2.8°, p < 0.05) values were found in the group that suffered for implant failure or adjacent disease. Moreover, patients who had undergone surgical revision showed higher LLM (23.7° vs. 11.6, p < 0.05), and PI-LL (19.9° vs. 3°, p < 0.05).

The oncological effectiveness of en bloc resections should be combined with a long-term effectiveness and stability of spinal implants, in order to avoid reduction of quality of life due to implant failure and re-hospitalizations for revision surgery. Our study found that for all included patients mechanical failures were strictly correlated with a mismatch between PI and LL. This suggests that the sagittal balance of the spine affects the endurance of surgical implants also in en bloc resection cases.