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논문 기본 정보

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학술저널
저자정보
Kumar Naresh (National University Health System Singapor) Patel Ravish (Orthopaedic Surgery National University Health System Singapore) Tan Jiong Hao (Orthopaedic Surgery National University Health System Singapore) Song Joshua (Orthopaedic Surgery National University Health System Singapore) Pandita Naveen (Orthopaedic Surgery National University Health System Singapore) Hey Dennis Hwee Weng (Orthopaedic Surgery National University Health System Singapore) Lau Leok Lim (Orthopaedic Surgery National University Health System Singapore) Liu Gabriel Ka-Po (National University Health System Singapore) Thambiah Joseph (National University Health System Singapore) Wong Hee-Kit (Orthopaedic Surgery National University Health System Singapore)
저널정보
대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.15 No.4
발행연도
2021.1
수록면
481 - 490 (10page)

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Study Design: Retrospective cohort study.Purpose: To evaluate the incidence and presentation of symptomatic failures (SFs) after metastatic spine tumor surgery (MSTS). To identify the associated risk factors. To categorize SFs based on the management in these patients.Overview of Literature: Few studies have reported on the incidence (1.9%–16%) and risk factors of SF after MSTS. It is unclear whether all SFs, occurring in MSTS-patients, result in revision surgery.Methods: We conducted a retrospective analysis on 288 patients (246 for final analysis) who underwent MSTS between 2005–2015. Data collected were demographics and peri/postoperative clinical and radiological features. Early and late radiological SF were defined as presentation before and after 3 months from index surgery, respectively. Univariate and multivariate models of competing risk regression analysis were designed to determine the risk factors for SF with death as a competing event.Results: We observed 14 SFs (5.7%) in 246 patients; 10 (4.1%) underwent revision surgery. Median survival was 13.4 months. The mean age was 58.8 years (range, 21–87 years); 48.4% were women. The median time to failure was 5 months (range, 1–60 months). Patients with SF were categorized into three groups: (1) SF when the primary implant was revised (n=5, 35.7%); (2) peri-construct progression of disease requiring extension (n=5, 35.7%); and (3) SFs that did not warrant revision (n=4, 28.5%). Four patients (28.5%) presented with early failure. SF commonly occurred at the implant-bone interface (9/14) and all patients had a spinal instability neoplastic score (SINS) >7. Thirteen patients (92.8%) who developed failure had fixation spanning junctional regions. Multivariate competing risk regression showed that preoperative Eastern Cooperative Oncology Group score was a significant risk factor for implant failure (adjusted sub-hazard ratio, 7.0; 95% confidence interval, 1.63–30.07; p<0.0009).Conclusions: The incidence of SF (5.7%) was low in patients undergoing MSTS although these patients did not undergo spinal fusion. Preoperative ambulators involved a 7 times higher risk of failure than non-ambulators. Preoperative SINS >7 and fixations spanning junctional regions were associated with SF. Majority of construct failures occurred at the implant-bone interface.
#Spine #Neoplasm metastasis #Surgery #Implants #Artificial #Implant failure

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참고문헌 (4)

참고문헌 신청
Bilsky MH / 2009 / Shifting paradigms in the treatment of metastatic spine disease / Spine (Phila Pa 1976) 34(22 Suppl):S101~S107 google schola 박성배 / 2018 / Instrumentation Failure after Partial Corpectomy with Instrumentation of a Metastatic Spine / 대한신경외과학회지 61(3):415~423 google schola Mesfin A / 2016 / Changing the adverse event profile in metastatic spine surgery: an evidence-based approach to target wound complications and instrumentation failure / Spine (Phila Pa 1976) 41(Suppl 20):S262~S270 google schola Quraishi NA / 2015 / Reoperation rates in the surgical treatment of spinal metastases / Spine J 15(3 Suppl):S37~S43 google schola

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