A Modified Spinal Reconstruction Method Reduces Instrumentation Failure in Total En Bloc Spondylectomy for Spinal Tumors

  • Shinmura Kazuya
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Demura Satoru
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Kato Satoshi
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Yokogawa Noriaki
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Handa Makoto
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Annen Ryohei
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Kobayashi Motoya
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Yamada Yohei
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Nagatani Satoshi
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University
  • Murakami Hideki
    Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences
  • Tsuchiya Hiroyuki
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University

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<p>Introduction: Long-term spinal stability after total en bloc spondylectomy (TES) is challenging. The aim of this study was to examine whether the new method could reduce the incidence of instrumentation failure (IF).</p><p>Methods: We retrospectively compared 116 patients with spinal tumors who underwent TES between 2010 and 2019 and were followed up for >1 year. IF, cage subsidence, and complications were evaluated. Propensity score matching between conventional and new method groups was performed for age, sex, body mass index, preoperative radiotherapy, number of resected vertebrae, number of instrumented vertebrae, tumor level, and follow-up period. There were 25 cases each in the conventional and new method groups. The conventional method used a titanium mesh cage for anterior reconstruction and 5.5-mm-diameter titanium alloy rods for posterior fixation. The new method used a more robust cage for anterior reconstruction, bone grafting was performed around the cage, and 6.0-mm-diameter cobalt chromium rods were used for posterior fixation. We compared the incidence of IF and cage subsidence after TES between the conventional and new method groups.</p><p>Results: While 5 out of 25 patients (20.0%) in the conventional method group experienced IF, none from the new method group experienced IF. Three-year implant survival rates were 87.3% in the conventional and 100% in the new method groups. The new method group had a significantly higher implant survival rate (p<0.01). Cage subsidence was observed in 11 of 25 (44/0%) patients in the conventional method and 1 of 25 (4.0%; significantly lower, p<0.05) in the new method group.</p><p>Conclusions: The new reconstruction method significantly reduced IF incidence in patients with TES.</p>

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