Rod fracture and related factors after total en bloc spondylectomy

Several studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or oligometastatic tumors. Considering that TES is indicated for patients with longer life expectancy, long-term instrumentation-related issues such as rod...

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Vydáno v:	The spine journal Ročník 19; číslo 10; s. 1613 - 1619
Hlavní autoři:	Park, Se-Jun, Lee, Chong-Suh, Chang, Bong-Soon, Kim, Young-Hoon, Kim, Hyoungmin, Kim, Sang-Il, Chang, Sam-Yeol
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.10.2019
Témata:	Adult Female Humans Lumbar level Lumbar Vertebrae - surgery Male Middle Aged Prostheses and Implants - adverse effects Prosthesis Failure - adverse effects Radiotherapy Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - instrumentation Reconstructive Surgical Procedures - methods Reoperation - statistics & numerical data Revision surgery Risk factor Rod fracture Spinal Neoplasms - surgery Total en bloc spondylectomy Total en bloc spondylectomy Radiotherapy Lumbar level Revision surgery Rod fracture Risk factor
ISSN:	1529-9430, 1878-1632, 1878-1632
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Abstract	Several studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or oligometastatic tumors. Considering that TES is indicated for patients with longer life expectancy, long-term instrumentation-related issues such as rod fracture needs to be addressed. To investigate delayed rod fracture and related factors after TES. Multicenter, retrospective study. Thirty-two patients who survived for more than 2 years after TES. Rod fracture and related factors. The relationships between rod fracture and related factors were investigated using Kaplan-Meier survivorship analysis with log-rank test. The analyzed factors were sex, age (<60 or ≥60), tumor histology (primary or metastatic), location of resected tumor (thoracic [above T11], thoracolumbar [cases including T12-L1], or lumbar [below L2]), number of resected vertebrae (1, 2, or 3), anterior support method (expandable cage, mesh cage, or strut bone graft), rod diameter (5.5 mm or 6.0 mm), and history of radiotherapy including preoperative or postoperative radiotherapy. The study population consisted of 18 men and 14 women, with a mean age of 49.0 years. Nineteen patients had primary tumors and 13 patients had metastatic tumors. The mean follow-up duration was 49.8 months (range, 24–166 months). Twelve of 32 patients (37.5%) experienced rod fractures at an average of 29.2 months (range, 8–93 months) after TES. Of these 12 patients, 8 underwent revision surgery caused by back pain aggravation (n = 7) or nonunion on computed tomography scan (n = 4). Location of resected tumor and history of radiotherapy were significantly associated with rod fracture (p = .004 and p = .019, respectively). Rod fracture was not a rare complication after TES surgery. History of radiotherapy and TES at lumbar level were significant risk factors related to rod fracture. A robust strategy to obtain solid osseous fusion should be considered when planning TES.
AbstractList	Several studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or oligometastatic tumors. Considering that TES is indicated for patients with longer life expectancy, long-term instrumentation-related issues such as rod fracture needs to be addressed.BACKGROUND CONTEXTSeveral studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or oligometastatic tumors. Considering that TES is indicated for patients with longer life expectancy, long-term instrumentation-related issues such as rod fracture needs to be addressed.To investigate delayed rod fracture and related factors after TES.PURPOSETo investigate delayed rod fracture and related factors after TES.Multicenter, retrospective study.STUDY DESIGNMulticenter, retrospective study.Thirty-two patients who survived for more than 2 years after TES.PATIENT SAMPLEThirty-two patients who survived for more than 2 years after TES.Rod fracture and related factors.OUTCOME MEASURESRod fracture and related factors.The relationships between rod fracture and related factors were investigated using Kaplan-Meier survivorship analysis with log-rank test. The analyzed factors were sex, age (<60 or ≥60), tumor histology (primary or metastatic), location of resected tumor (thoracic [above T11], thoracolumbar [cases including T12-L1], or lumbar [below L2]), number of resected vertebrae (1, 2, or 3), anterior support method (expandable cage, mesh cage, or strut bone graft), rod diameter (5.5 mm or 6.0 mm), and history of radiotherapy including preoperative or postoperative radiotherapy.METHODSThe relationships between rod fracture and related factors were investigated using Kaplan-Meier survivorship analysis with log-rank test. The analyzed factors were sex, age (<60 or ≥60), tumor histology (primary or metastatic), location of resected tumor (thoracic [above T11], thoracolumbar [cases including T12-L1], or lumbar [below L2]), number of resected vertebrae (1, 2, or 3), anterior support method (expandable cage, mesh cage, or strut bone graft), rod diameter (5.5 mm or 6.0 mm), and history of radiotherapy including preoperative or postoperative radiotherapy.The study population consisted of 18 men and 14 women, with a mean age of 49.0 years. Nineteen patients had primary tumors and 13 patients had metastatic tumors. The mean follow-up duration was 49.8 months (range, 24-166 months). Twelve of 32 patients (37.5%) experienced rod fractures at an average of 29.2 months (range, 8-93 months) after TES. Of these 12 patients, 8 underwent revision surgery caused by back pain aggravation (n = 7) or nonunion on computed tomography scan (n = 4). Location of resected tumor and history of radiotherapy were significantly associated with rod fracture (p = .004 and p = .019, respectively).RESULTSThe study population consisted of 18 men and 14 women, with a mean age of 49.0 years. Nineteen patients had primary tumors and 13 patients had metastatic tumors. The mean follow-up duration was 49.8 months (range, 24-166 months). Twelve of 32 patients (37.5%) experienced rod fractures at an average of 29.2 months (range, 8-93 months) after TES. Of these 12 patients, 8 underwent revision surgery caused by back pain aggravation (n = 7) or nonunion on computed tomography scan (n = 4). Location of resected tumor and history of radiotherapy were significantly associated with rod fracture (p = .004 and p = .019, respectively).Rod fracture was not a rare complication after TES surgery. History of radiotherapy and TES at lumbar level were significant risk factors related to rod fracture. A robust strategy to obtain solid osseous fusion should be considered when planning TES.CONCLUSIONRod fracture was not a rare complication after TES surgery. History of radiotherapy and TES at lumbar level were significant risk factors related to rod fracture. A robust strategy to obtain solid osseous fusion should be considered when planning TES. Several studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or oligometastatic tumors. Considering that TES is indicated for patients with longer life expectancy, long-term instrumentation-related issues such as rod fracture needs to be addressed. To investigate delayed rod fracture and related factors after TES. Multicenter, retrospective study. Thirty-two patients who survived for more than 2 years after TES. Rod fracture and related factors. The relationships between rod fracture and related factors were investigated using Kaplan-Meier survivorship analysis with log-rank test. The analyzed factors were sex, age (<60 or ≥60), tumor histology (primary or metastatic), location of resected tumor (thoracic [above T11], thoracolumbar [cases including T12-L1], or lumbar [below L2]), number of resected vertebrae (1, 2, or 3), anterior support method (expandable cage, mesh cage, or strut bone graft), rod diameter (5.5 mm or 6.0 mm), and history of radiotherapy including preoperative or postoperative radiotherapy. The study population consisted of 18 men and 14 women, with a mean age of 49.0 years. Nineteen patients had primary tumors and 13 patients had metastatic tumors. The mean follow-up duration was 49.8 months (range, 24–166 months). Twelve of 32 patients (37.5%) experienced rod fractures at an average of 29.2 months (range, 8–93 months) after TES. Of these 12 patients, 8 underwent revision surgery caused by back pain aggravation (n = 7) or nonunion on computed tomography scan (n = 4). Location of resected tumor and history of radiotherapy were significantly associated with rod fracture (p = .004 and p = .019, respectively). Rod fracture was not a rare complication after TES surgery. History of radiotherapy and TES at lumbar level were significant risk factors related to rod fracture. A robust strategy to obtain solid osseous fusion should be considered when planning TES.
Author	Kim, Hyoungmin Chang, Sam-Yeol Lee, Chong-Suh Kim, Sang-Il Park, Se-Jun Kim, Young-Hoon Chang, Bong-Soon
Author_xml	– sequence: 1 givenname: Se-Jun surname: Park fullname: Park, Se-Jun organization: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea – sequence: 2 givenname: Chong-Suh surname: Lee fullname: Lee, Chong-Suh email: sejunos.park@samsung.com organization: Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea – sequence: 3 givenname: Bong-Soon surname: Chang fullname: Chang, Bong-Soon organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea – sequence: 4 givenname: Young-Hoon surname: Kim fullname: Kim, Young-Hoon organization: Department of Orthopedic Surgery, Seoul St. Mary Hospital, Catholic University School of Medicine, Seoul, Korea – sequence: 5 givenname: Hyoungmin surname: Kim fullname: Kim, Hyoungmin organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea – sequence: 6 givenname: Sang-Il surname: Kim fullname: Kim, Sang-Il organization: Department of Orthopedic Surgery, Seoul St. Mary Hospital, Catholic University School of Medicine, Seoul, Korea – sequence: 7 givenname: Sam-Yeol surname: Chang fullname: Chang, Sam-Yeol organization: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
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Keywords	Total en bloc spondylectomy Radiotherapy Lumbar level Revision surgery Rod fracture Risk factor
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Snippet	Several studies have reported favorable oncosurgical outcomes after total en bloc spondylectomy (TES) for treatment of primary malignant tumors or...
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SubjectTerms	Adult Female Humans Lumbar level Lumbar Vertebrae - surgery Male Middle Aged Prostheses and Implants - adverse effects Prosthesis Failure - adverse effects Radiotherapy Reconstructive Surgical Procedures - adverse effects Reconstructive Surgical Procedures - instrumentation Reconstructive Surgical Procedures - methods Reoperation - statistics & numerical data Revision surgery Risk factor Rod fracture Spinal Neoplasms - surgery Total en bloc spondylectomy
Title	Rod fracture and related factors after total en bloc spondylectomy
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