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Morio Matsumoto, Kota Watanabe, Takashi Tsuji, Ken Ishii, Masaya Nakamura, Kazuhiro Chiba and Yoshiaki Toyama

TES can lead to serious sequelae, including severe pain and neurological deterioration. Because TES is indicated for patients with a long life expectancy, 15 such patients may face a greater risk of suffering from instrumentation failure during a later stage of follow-up than the patients with a shorter life expectancy, who usually undergo palliative intralesional resection surgery. Late instrumentation failure can be caused by the lack of biological osseous fusion, but patients who undergo TES suffer from many factors unfavorable to osseous fusion, including

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Antoine Jaeger, David Giber, Claire Bastard, Benjamin Thiebaut, François Roubineau, Charles Henri Flouzat Lachaniette and Arnaud Dubory

imposed on the intervertebral disc. Shear forces, which are highest in L5–S1 isthmic spondylolisthesis, tend to compromise intervertebral fusion. Currently, surgeons have no methods to predict the risk of instrumentation failure in L5–S1 stand-alone ALIFs, which would necessitate the planning of adjuvant posterior instrumentation after the anterior surgery. Some authors have suggested that L5–S1 isthmic spondylolisthesis could be a risk factor for instrumentation failure. 22 , 34 The aim of the present monocentric retrospective cohort study was to identify the risk

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Hannah M. Carl, A. Karim Ahmed, Nancy Abu-Bonsrah, Rafael De la Garza Ramos, Eric W. Sankey, Zachary Pennington, Ali Bydon, Timothy F. Witham, Jean-Paul Wolinsky, Ziya L. Gokaslan, Justin M. Sacks, C. Rory Goodwin and Daniel M. Sciubba

morbidity and mortality. 15 , 19 , 33 These include wound infections, wound dehiscence, hematomas, neurological impairments, deep venous thrombosis, and instrumentation failure, among others. 15 , 33 In patients with metastatic spine tumors, overall complication rates range between 19% and 28%, 30 , 33 , 34 whereas the incidence of surgical site infection and wound breakdown is 4%–20%. 8 , 20 , 23 , 26 Crucially, the most common reason for reoperation after the resection of spinal metastases is surgical site infection, which commonly leads to wound breakdown. 26

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Yu Yamato, Tomohiko Hasegawa, Sho Kobayashi, Tatsuya Yasuda, Daisuke Togawa, Go Yoshida, Tomohiro Banno, Shin Oe, Yuki Mihara and Yukihiro Matsuyama

.1007/s00586-014-3555-9 25238797 12 Luca A , Ottardi C , Sasso M , Prosdocimo L , Luca A : Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs . Eur Spine J 26 : 764 – 770 , 2017 10.1007/s00586-016-4859-8 27858238 13 Pellisé F , Vila-Casademunt A , Ferrer M , Domingo-Sàbat M , Bagó J , Pérez-Grueso FJS , : Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions . Eur Spine J 24 : 3 – 11 , 2015

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Joshua M. Rosenow, Michael Stanton-Hicks, Ali R. Rezai and Jaimie M. Henderson


Epidural spinal cord stimulation (SCS) is effective at treating refractory pain. The failure modes of the implanted hardware, however, have not been well studied. A better understanding of this could aid in improving the current procedure or designing future devices.


The authors reviewed electronic charts and operative reports of 289 patients who had undergone SCS implantation between 1998 and 2002 at the Cleveland Clinic Foundation. Data were collected on demographics, type of hardware, date of implantation procedure, indication for treatment, time to failure, and failure mode. Data were then analyzed to identify significant differences.

A total of 577 procedures were performed, 43.5% of which involved revision or removal of SCS hardware. The most common indication was complex regional pain syndrome 1, and this was followed by failed–back surgery syndrome. The median number of procedures per patient was two. Approximately 80% of all leads were the percutaneous type. The majority (62%) of leads were placed in the thoracic region, and 33.5% of all leads required revision. Poor pain relief coverage was the most common indication for revision. Surgically implanted leads broke twice as often as percutaneous leads. In 46% of the patients, hardware revision was required, and multiple revisions were necessary in 22.5%. Three-way ANOVA revealed significant differences in failure mode rates according to location (cervical compared with thoracic, p = 0.037) and failure modes (p = 0.019). Laminotomy leads tended to break and migrate sooner than percutaneous leads. Thoracic leads became infected sooner than cervical leads.


The results of this analysis of SCS hardware failures may be used as a basis for refining surgical technique and designing the next generation of SCS hardware.

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Shinya Okuda, Takenori Oda, Ryoji Yamasaki, Takamitsu Haku, Takafumi Maeno and Motoki Iwasaki

arthrodesis site is larger with reduction. 2 , 3 , 19 , 31 On the other hand, the reduction maneuver sometimes causes neurological deficits or instrumentation failure. 8 , 17 , 20 , 29 , 31 T here have been few reports of the degree of slip reduction, 10 , 15 , 32 and furthermore there have been no reports about appropriate slip reduction. The purpose of this study was to investigate the following issues: 1) surgical outcomes of PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis, including postoperative complications; 2) effects of slip reduction

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Dae-Jean Jo, Eun-Min Seo, Ki-Tack Kim, Sung-Min Kim and Sang-Hun Lee

instrumentation failure, progressive slippage, severe sagittal imbalance, and pseudarthrosis. In an attempt to restore sagittal balance and increase the fusion rate while reducing the neurological risk associated with the reduction of spondyloptosis in the osteoporotic elderly patient, we used partial reduction and pedicular transvertebral screw fixation of the lumbosacral junction. 1 , 2 , 14 , 19 , 20 This procedure resembles the procedure described by Abdu et al. 1 , 2 except that we performed it in 2 stages. We also performed additional anterior lumbar interbody fusion

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Dimitrios Mathios, Paul Edward Kaloostian, Ali Bydon, Daniel M. Sciubba, Jean Paul Wolinsky, Ziya L. Gokaslan and Timothy F. Witham

technique has been deployed with success at our institution and we have not encountered any occurrences of instrumentation failure in our series. We illustrate the application of this unique construct in our first 3 cases, with the first 2 cases being discussed in more detail. Methods Patient Demographics Three consecutive patients underwent surgery for reconstruction of the anterior lumbosacral junction with the VLIFT cage system. The mean age of the patients was 49.3 years (their individual ages were 45, 58, and 45 years). All 3 patients had neoplastic

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Robin Bhatia, Ruth M. Desouza, Jonathan Bull and Adrian T. H. Casey

article addresses trends in indications, operative details, complications (particularly instrumentation failure), and outcomes as they relate to diagnostic subcategories. Methods Patient Population and Outcome Assessment A prospective database of patients undergoing spinal surgery at The National Hospital for Neurology and Neurosurgery was retrospectively searched for the procedure of OCF (or posterior cervical fusion with extension to the occiput). One hundred consecutive patients were identified with baseline demographic data, including age, sex, underlying

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Corbett D. Winegar, James P. Lawrence, Brian C. Friel, Carmella Fernandez, Joseph Hong, Mitchell Maltenfort, Paul A. Anderson and Alexander R. Vaccaro

create a stable biomechanical environment and provide the biological requirements for osseous fusion. 3 Adequate decompression of the neurological structures (when necessary) and recreation of normal sagittal and coronal alignment are necessary prerequisites before an arthrodesis procedure. 47 Because of the nature and location of this surgical procedure, adverse events can be serious and cause further neurological injury or impairment, vascular injury, CSF egress, infection, instrumentation failure, pseudarthrosis, continued instability, and pain. 2 , 3 , 47