Implantatversagen HWS-LWS nach langstreckigen Instrumentierungen beim Knochengesunden – Ursachen und Behandlungskonzepte

Zusammenfassung

Ein Implantatversagen bei langstreckigen Instrumentation droht insbesondere bei nicht Erreichen einer regelrechten Balance. Hierbei treten insbesondere Anschlusskyphosierung mit Anschlussfrakturen oder Schrauben-cut-outs auf. Bei der operativen Revision sollten die lumbopelvinen Parameter ermittelt und entschieden werden, ob eine Osteotomie zusätzlich zur Verlängerung der Instrumentationsstrecke erforderlich ist.

Im lumbosakralen Übergang besteht ein erhöhtes Pseudarthroserisiko bei postoperativ persistierender sagittaler Dysbalance oder mangelhafter lumbosakraler Fixierung. Bei der Revision einer Pseudarthrose muss diese vollständig reseziert und stabil und mit einem pressfiten mit Knochen oder BMP befüllten Implantat abgestützt werden. Dorsal sollte die Instrumentierung bis aufs Ilium verlängert werden.

Abstract

Implant failure is at risk in long instrumentations with sagittal imbalance. This could lead to a proximal junctional kyphosis with adjacent fractures or screw-cut-outs. In advance of revision surgery, spinopelvic parameters should be measured in order to decide whether osteotomies are also needed, including lengthening of instrumentation.

Pseudarthrosis in the lumbosacral region increases in presence of sagittal imbalance or lack of proper lumbosacral fixation. Revison of lumbosacral pseudarthrosis needs a complete resection and pressfit stabilization with a bone or BMP filled device. The posterior instrumentation should be lengthening down to the ilium.

Schlüsselwörter

Implantatversagen - Schraubenlockerungen - Implantatbruch - Pseudarthrose - Korrekturverlust

Keywords

Implant failure - screw loosening - implant breakage - pseudarthrosis - loss of correction

Publication History

Article published online:
17 May 2022

• Literatur

• 1 Pumberger M, Schmidt H, Putzier M. Spinal Deformity Surgery: A critical review of alignment and balance. Asian Spine J 2013; 22: 42-46 DOI: 10.31616/asj.2018.12.4.775. (PMID: 30060389)
• 2 Maier SP, Smith JS, Schwab FJ. et al. Revision surgery after 3-column osteotomy in 335 patients with adult spinal deformity: intercenter variability and risk factors. Spine 2014; 39: 881-885 DOI: 10.1097/BRS.0000000000000304. (PMID: 24583729)
• 3 Blondel B, Schwab F, Bess S. et al. Posterior global malalignment after osteotomy for sagittal plane deformity: it happens and here is why. Spine 2013; 38: E394-E401 DOI: 10.1097/BRS.0b013e3182872415. (PMID: 23324927)
• 4 Lafage V, Bharucha NJ, Schwab F. et al. Multicenter validation of a formula predicting postoperative spinopelvic alignment. J Neurosurg Spine 2012; 16: 15-21 DOI: 10.3171/2011.8.SPINE11272 . (PMID: 21943245)
• 5 Pichelmann MA, Lenke LG, Bridwell KH. et al. Revision rates following primary adult spinal deformity surgery: six hundred forty-three consecutive patients followed-up to twenty-two years postoperative. Spine 2010; 35: 219-226 DOI: 10.1097/BRS.0b013e3181c91180. (PMID: 20038867)
• 6 Singh V, Mahajan R, Das K. et al. Surgical trendanalysis for the use of cement augmented pedicle screws in osteoporosis of spine: a systematic review (2000–2017). Global Spine J 2019; 9: 783-795
• 7 De Kunder SL, Rijkers K, Caelers IJMH. et al. Lumbar interbody fusion: a historical overview and a future perspective. Spine 2018; 43: 1162-1168
• 8 Jain A, Hassanzadeh H, Strike SA. et al. Pelvic fixation in adult and pediatric spine surgery: historical perspective, indications, and techniques: AAOS exhibit selection. J Bone Joint Surg Am 2015; 97: 1521-8 DOI: 10.2106/JBJS.O.00576. (PMID: 26378268)
• 9 Janjua MB, Ackshota N, Arlet V. Technical consideration for TLIF cage retrieval and deformity correction with anterior interbody fusion in lumbar revision surgeries. Spine Deform 2019; 7: 633-640 DOI: 10.1016/j.jspd.2018.10.004. (PMID: 31202382)
• 10 Garcia-Perez D, Lagares A, Castano-Leon AM. et al. Implant mikrobial colonization detected by sonication as a cause for spinaldevice failure: a prospective study. Spine 2021; 46: 1485-1494 DOI: 10.1097/BRS.0000000000004063. (PMID: 34618709)
• 11 Yang M, Zhao Y, Yin X. et al. Prevalence, risk factors, and characteristics on the „Adding –On“ phenomenon in idiopathic scoliosis after correction surgery: a systematic review and meta-analysis. Spine 2018; 43: 780-790 DOI: 10.1097/BRS.0000000000002423. (PMID: 28937532)
• 12 Potter BK, Kirk KL, Shah SA. et al. Loss of coronal correction following instrumentation removal in adolescent idiopathic scoliosis. Spine 2006; 31: 67-72 DOI: 10.1097/01.brs.0000192721.51511.fe. (PMID: 16395179)
• 13 Kim YJ, Bridwell KH, Lenke LG. et al. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis in 144 cases. Spine 2006; 31: 2329-36 DOI: 10.1097/01.brs.0000238968.82799.d9. (PMID: 16985461)
• 14 Buser Z, Brodke DS, Youssef JS. et al. Synthetic bone graft versus autograft or allograft for spinal fusion: a systematic review. J Neurosurg Spine 2016; 509-516 DOI: 10.3171/2016.1.SPINE151005. (PMID: 27231812)