Evaluation of Stabilization failure in Thoracolumber spine
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The document evaluates stabilization failure in the thoracolumbar spine. It analyzes 93 patients who underwent spinal stabilization surgery. 9 patients (8.37%) experienced implant failure, mostly screw breakage. Failure was likely due to inadequate bone grafting, poor surgical technique, use of undersized screws, low-quality implants, inadequate rest after surgery, or trauma after surgery. The study aims to identify failure causes and prevent future failures through limiting stabilization use, good technique, proper implant choice, adequate grafting, and considering spinal biomechanics.
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Externalbeam rt in ews3.12.20 - frida yseminar-finallll
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- 1. Evaluation of Stabilization failure in Thoracolumber spine Dr. Md. Shafiul Alam Dr. Ferdous Ara Islam NINS&H
- 3. Introduction Stabilization of Thoracolumber, Lumber and Lumbosacral spine is a common surgical procedures. This surgery become more popular in our country for last two decades. Stabilization by transpedicular screws and rods through posterior approach are preferred.
- 4. Indications of stabilization were • Traumatic fracture • Osteoporotic fracture • Primary bone lession • Secondaries in the spine • Tuberculosis of the spine • Spondylolisthesis
- 5. • Failure of transpedicular screws and rods are not uncommon. Now it is a challenging surgical issue. • The purpose of study was to find out the causes of failure and ways to avoid it as much as possible.
- 6. Materials and Methods Study Design It was a retrospective study. Study Period January 2007 to December 2015
- 7. Patient selection criteria All patient of stabilization of Thoracolumber, Lumber and Lumbosacral spine by pedicle screws and rods for different indications were included in this study.
- 8. Evaluation of the patient Implant status was assessed on the basis on Intra-operative immediate post-operative and follow up X-Ray findings. The mean duration of follow up was 2 years. Range, 1month -3 years.
- 9. Implant failure and radiological analysis • The postoperative plain radiological studies includes the standard A/P and Lat. Views. • Successful fusion was determined by evaluating the radiographs for the presence bridging bone between the fused segments.
- 10. The radiographs were interpreted for – Manifestation of failure of fixation – Effect of implant failure – The point of implant failure – Screw length and diameter – Rod length and diameter – Status of bone graft
- 11. The common complications were seen – Screw misplacement – Breakage of screws – Breakage of rods – Loosening of screws and rods
- 12. Results Total No. of cases : 93 Male : 61 Female : 32 61 32 Sex Male Female
- 13. Total no. of failed cases : 9 • Male : 5 • Female : 4 5 4 Male Female
- 14. Types of failure : Breakage of screws - 8 Breakage of rods - 1 Loosening of screws -3 8 1 3 Breakage of screws Breakage of rods Loosening of screws
- 15. Probable causes of implant failure • Absence of adequate bone graft • Failure to bone fusion • Poor surgical technique • Use less diameter screws • Poor quality of implants • Inadequate rest after surgery • Trauma after surgery • Short fixation
- 16. Case no. – 1 F 46y, Spondylolisthesis, 5m
- 17. Case no. – 2 M 52y, HOF, 8m
- 18. Case no. – 3 F 43y, Spondylolisthesis, 3m
- 19. Case no. – 4 M 35, FFH, 12m
- 20. Case no. – 5 M 25y, RTA, 7m
- 21. Case no. – 6 F 52y, Osteoporotic, 12m
- 22. Case no. – 7 M 43y, RTA, 8m
- 23. Case no. – 8 M 32y, FFH, 6m
- 24. Case no. – 9 F 23y, TB, 15m
- 25. Results • Among 93 cases 9 cases (8.37%) had stabilization failure. And others had improved. • Of these 5 cases were male (55.55%) and 4 were female (44.45%).
- 26. Flow chart of failed cases Sl. No. Sex Age (yrs) Indication Followup (Months) 1 F 46 Spondylolisthesis 5 2 M 52 Fall from Height 8 3 F 43 Spondylolisthesis 3 4 M 35 Fall from height 12 5 M 25 RTA 7 6 F 52 Osteoporotic fracture 12 7 M 43 RTA 8 8 M 32 Fall from Height 6 9 F 23 TB Spine 15
- 27. Prevention of Implant failure • Limiting the use of stabilization • Good surgical technique • Adequate bone grafting • Use of cages where indicated • Proper choice of screw and rod • Use of good quality implants • Use of more screws in junctional regions • Considering the biomechanics of the spine
- 28. Conclusion Failure of implanted pedicle screws and rods are not unavoidable complications. Failure to provide adequate stabilization can necessitate additional surgical procedures to achieve spinal fusion. An understanding of fundamental biomechanical principles of the spine, fixation strategies and good surgical technique are essential to avoid unnecessary subsequent failures.