Incidence and Predictors of Hardware Failure After Instrumentation for Spine Metastasis: A Single-Institutional Series

Michael Longo, Rafael De la Garza Ramos, Yaroslav Gelfand, Murray Echt, Merritt D. Kinon, Reza Yassari

Research output: Contribution to journalArticle

Abstract

Objective: We report a retrospective analysis of hardware failure in patients requiring instrumentation for spinal metastasis. Methods: In a retrospective study at a single institution, we identified 58 patients who underwent spinal instrumentation for metastasis from 2012 to 2018. Hardware failure was defined as screw pullout/loosening, cage migration, progressive kyphosis, or an otherwise-noticeable instrumentation deficit detectable on imaging. Risk factors for hardware failure with a P < 0.05 in in univariate were included in multivariate logistic regression models controlled for age, sex, and previously identified risk factors for hardware failure. Results: In total, 58 patients required instrumentation for metastatic spine disease. Median age was 60.2 years (interquartile range 49.0–66.3), 38 patients (65.5%) were male, and median follow-up was 8.1 months (interquartile range 3.1–20.7). Eight patients (13.8%) developed signs of hardware failure during follow-up, of whom 2 patients (3.4%) underwent operative revision. In univariate analysis, Eastern Cooperative Oncology Group performance status >2 (P = 0.049) and multiple myeloma lesions (P = 0.010) were significant predictors of failure. Both factors maintained significance in a multivariate logistic regression model controlled for age, sex, history of spine radiation, and number of fused levels with P = 0.047; odds ratio 12.7 (95% confidence interval 1.03–156.4) for Eastern Cooperative Oncology Group performance status over 2 and P = 0.012; odds ratio 31.5 (95% confidence interval 2.2–460.0) for multiple myeloma lesions. Conclusions: The rate of hardware failure in this cohort was 13.8%, although operative revision rate was 3.4%. Spinal instrumentation in patients with poor preoperative functional status or multiple myeloma may be more likely to develop instrumentation failure.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StatePublished - Jan 1 2019

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Multiple Myeloma
Spine
Neoplasm Metastasis
Incidence
Logistic Models
Odds Ratio
Confidence Intervals
Kyphosis
Retrospective Studies
Radiation

Keywords

  • Hardware failure
  • Instrumentation failure
  • Multiple myeloma
  • Spine metastasis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Incidence and Predictors of Hardware Failure After Instrumentation for Spine Metastasis : A Single-Institutional Series. / Longo, Michael; De la Garza Ramos, Rafael; Gelfand, Yaroslav; Echt, Murray; Kinon, Merritt D.; Yassari, Reza.

In: World Neurosurgery, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Incidence and Predictors of Hardware Failure After Instrumentation for Spine Metastasis: A Single-Institutional Series",
abstract = "Objective: We report a retrospective analysis of hardware failure in patients requiring instrumentation for spinal metastasis. Methods: In a retrospective study at a single institution, we identified 58 patients who underwent spinal instrumentation for metastasis from 2012 to 2018. Hardware failure was defined as screw pullout/loosening, cage migration, progressive kyphosis, or an otherwise-noticeable instrumentation deficit detectable on imaging. Risk factors for hardware failure with a P < 0.05 in in univariate were included in multivariate logistic regression models controlled for age, sex, and previously identified risk factors for hardware failure. Results: In total, 58 patients required instrumentation for metastatic spine disease. Median age was 60.2 years (interquartile range 49.0–66.3), 38 patients (65.5{\%}) were male, and median follow-up was 8.1 months (interquartile range 3.1–20.7). Eight patients (13.8{\%}) developed signs of hardware failure during follow-up, of whom 2 patients (3.4{\%}) underwent operative revision. In univariate analysis, Eastern Cooperative Oncology Group performance status >2 (P = 0.049) and multiple myeloma lesions (P = 0.010) were significant predictors of failure. Both factors maintained significance in a multivariate logistic regression model controlled for age, sex, history of spine radiation, and number of fused levels with P = 0.047; odds ratio 12.7 (95{\%} confidence interval 1.03–156.4) for Eastern Cooperative Oncology Group performance status over 2 and P = 0.012; odds ratio 31.5 (95{\%} confidence interval 2.2–460.0) for multiple myeloma lesions. Conclusions: The rate of hardware failure in this cohort was 13.8{\%}, although operative revision rate was 3.4{\%}. Spinal instrumentation in patients with poor preoperative functional status or multiple myeloma may be more likely to develop instrumentation failure.",
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AU - Longo, Michael

AU - De la Garza Ramos, Rafael

AU - Gelfand, Yaroslav

AU - Echt, Murray

AU - Kinon, Merritt D.

AU - Yassari, Reza

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N2 - Objective: We report a retrospective analysis of hardware failure in patients requiring instrumentation for spinal metastasis. Methods: In a retrospective study at a single institution, we identified 58 patients who underwent spinal instrumentation for metastasis from 2012 to 2018. Hardware failure was defined as screw pullout/loosening, cage migration, progressive kyphosis, or an otherwise-noticeable instrumentation deficit detectable on imaging. Risk factors for hardware failure with a P < 0.05 in in univariate were included in multivariate logistic regression models controlled for age, sex, and previously identified risk factors for hardware failure. Results: In total, 58 patients required instrumentation for metastatic spine disease. Median age was 60.2 years (interquartile range 49.0–66.3), 38 patients (65.5%) were male, and median follow-up was 8.1 months (interquartile range 3.1–20.7). Eight patients (13.8%) developed signs of hardware failure during follow-up, of whom 2 patients (3.4%) underwent operative revision. In univariate analysis, Eastern Cooperative Oncology Group performance status >2 (P = 0.049) and multiple myeloma lesions (P = 0.010) were significant predictors of failure. Both factors maintained significance in a multivariate logistic regression model controlled for age, sex, history of spine radiation, and number of fused levels with P = 0.047; odds ratio 12.7 (95% confidence interval 1.03–156.4) for Eastern Cooperative Oncology Group performance status over 2 and P = 0.012; odds ratio 31.5 (95% confidence interval 2.2–460.0) for multiple myeloma lesions. Conclusions: The rate of hardware failure in this cohort was 13.8%, although operative revision rate was 3.4%. Spinal instrumentation in patients with poor preoperative functional status or multiple myeloma may be more likely to develop instrumentation failure.

AB - Objective: We report a retrospective analysis of hardware failure in patients requiring instrumentation for spinal metastasis. Methods: In a retrospective study at a single institution, we identified 58 patients who underwent spinal instrumentation for metastasis from 2012 to 2018. Hardware failure was defined as screw pullout/loosening, cage migration, progressive kyphosis, or an otherwise-noticeable instrumentation deficit detectable on imaging. Risk factors for hardware failure with a P < 0.05 in in univariate were included in multivariate logistic regression models controlled for age, sex, and previously identified risk factors for hardware failure. Results: In total, 58 patients required instrumentation for metastatic spine disease. Median age was 60.2 years (interquartile range 49.0–66.3), 38 patients (65.5%) were male, and median follow-up was 8.1 months (interquartile range 3.1–20.7). Eight patients (13.8%) developed signs of hardware failure during follow-up, of whom 2 patients (3.4%) underwent operative revision. In univariate analysis, Eastern Cooperative Oncology Group performance status >2 (P = 0.049) and multiple myeloma lesions (P = 0.010) were significant predictors of failure. Both factors maintained significance in a multivariate logistic regression model controlled for age, sex, history of spine radiation, and number of fused levels with P = 0.047; odds ratio 12.7 (95% confidence interval 1.03–156.4) for Eastern Cooperative Oncology Group performance status over 2 and P = 0.012; odds ratio 31.5 (95% confidence interval 2.2–460.0) for multiple myeloma lesions. Conclusions: The rate of hardware failure in this cohort was 13.8%, although operative revision rate was 3.4%. Spinal instrumentation in patients with poor preoperative functional status or multiple myeloma may be more likely to develop instrumentation failure.

KW - Hardware failure

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KW - Multiple myeloma

KW - Spine metastasis

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