Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF)
Abstract Background For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological le...
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| Format: | Article |
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BMC
2024-01-01
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| Series: | BMC Musculoskeletal Disorders |
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| Online Access: | https://doi.org/10.1186/s12891-023-07116-z |
| _version_ | 1827388809997713408 |
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| author | Zejun Chen Guohua Lv Ou Zhang Yunchao Li Xiaoxiao Wang Haoyu He Hui Yuan Changyu Pan Lei Kuang |
| author_facet | Zejun Chen Guohua Lv Ou Zhang Yunchao Li Xiaoxiao Wang Haoyu He Hui Yuan Changyu Pan Lei Kuang |
| author_sort | Zejun Chen |
| collection | DOAJ |
| description | Abstract Background For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. Methods The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. Results We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12–30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). Conclusions Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up. |
| first_indexed | 2024-03-08T16:25:24Z |
| format | Article |
| id | doaj.art-743d8143247641a29d1ba31b3fec5173 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-03-08T16:25:24Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
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| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-743d8143247641a29d1ba31b3fec51732024-01-07T12:04:06ZengBMCBMC Musculoskeletal Disorders1471-24742024-01-012511910.1186/s12891-023-07116-zRisk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF)Zejun Chen0Guohua Lv1Ou Zhang2Yunchao Li3Xiaoxiao Wang4Haoyu He5Hui Yuan6Changyu Pan7Lei Kuang8Department of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityCalifornia University of Science and MedicineDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityDepartment of Spinal Surgery, The Second Xiangya Hospital of Central South UniversityAbstract Background For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation. Methods The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups. Results We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12–30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001). Conclusions Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.https://doi.org/10.1186/s12891-023-07116-zHardware failureLaminectomy and posterior cervical fusionDegenerative cervical myelopathyOsteoporosisHounsfield unitsScrew density |
| spellingShingle | Zejun Chen Guohua Lv Ou Zhang Yunchao Li Xiaoxiao Wang Haoyu He Hui Yuan Changyu Pan Lei Kuang Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) BMC Musculoskeletal Disorders Hardware failure Laminectomy and posterior cervical fusion Degenerative cervical myelopathy Osteoporosis Hounsfield units Screw density |
| title | Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) |
| title_full | Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) |
| title_fullStr | Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) |
| title_full_unstemmed | Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) |
| title_short | Risk factors of instrumentation failure after laminectomy and posterior cervical fusions (PCF) |
| title_sort | risk factors of instrumentation failure after laminectomy and posterior cervical fusions pcf |
| topic | Hardware failure Laminectomy and posterior cervical fusion Degenerative cervical myelopathy Osteoporosis Hounsfield units Screw density |
| url | https://doi.org/10.1186/s12891-023-07116-z |
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