Fractures After Removal of Spinal Instrumentation: Revisiting the Stress-Shielding Effect of Instrumentation in Spine Fusion
| Autor: | Kenneth Thomas, Fred Nicholls, Peter Lewkonia, Daniel Yavin, Ganesh Swamy, Alisson Roberto Teles, Christos P. Zafeiris, W Bradley Jacobs |
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| Rok vydání: | 2018 |
| Předmět: |
Reoperation
medicine.medical_specialty Spinal fusion surgery medicine.medical_treatment Computed tomography 03 medical and health sciences Fractures Bone 0302 clinical medicine Spine fusion Medicine Humans Aged Retrospective Studies 030222 orthopedics Lumbar Vertebrae Spinal instrumentation medicine.diagnostic_test business.industry Biomechanics Prostheses and Implants Stress shielding Middle Aged Spinal column Spine Spinal Fusion Spinal fusion Surgery Female Spinal Diseases Neurology (clinical) Radiology business 030217 neurology & neurosurgery |
| Zdroj: | World neurosurgery. 116 |
| ISSN: | 1878-8769 |
| Popis: | Background Many practicing spine surgeons believe that instrumentation can be removed during revision surgery in successful posterolateral or anterior spinal fusions, confirmed by computed tomography and intraoperative exploration. The stress-shielding effect of spinal instrumentation was well described in the late 1980s and 1990s but has not received recent attention. Despite the paucity of recent literature, concepts underlying the biology and biomechanics of the spinal fusion mass remain particularly salient given the increasing incidence of revision spinal fusion surgery. The aim of this study was to highlight a potential complication of instrumentation removal owing to stress shielding of instrumentation on the spinal column and fusion mass. Methods A retrospective review was performed, and a small case series was described. Results In 3 cases, despite apparent solid fusion demonstrated on preoperative computed tomography and confirmed by intraoperative exploration, new fractures developed after removal of instrumentation. In these cases, fracture occurred at the transition zone between the newly rigid instrumented area and previous fusion. This highlights the relative weakness of the fusion and may be explained by the stress-shielding effect of instrumentation within the fusion mass. Conclusions Spinal instrumentation revision requires careful consideration, and routine implant removal should not be performed. The presence of a solid fusion on computed tomography and/or at intraoperative exploration may not justify implant removal in these cases. In cases of extension of a fusion, use of a bridging connection to the new implants should be considered. The cases presented demonstrate the consequences of the stress-shielding effect of implants on the spine and fusion mass. |
| Databáze: | OpenAIRE |
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