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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 7, pp 1834–1846 | Cite as

Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant?

  • Eike HoffEmail author
  • Patrick Strube
  • Antonius Rohlmann
  • Christian Groß
  • Michael Putzier
Symposium: Retrieval Studies

Abstract

Background

Knowledge about factors leading to failure of posterior dynamic stabilization implants is essential to design future implants and establish surgical indications. Therefore, we analyzed an implant for single-level or hybrid configuration (adjacent to spondylodesis), which was recalled due to high failure rates.

Questions/purposes

We asked: (1) Were postoperative radiographic changes linked to implant failure? (2) Were radiographic parameters different between the two configurations? And (3) was implant failure related to inferior clinical scores?

Methods

The implant was used in 18 patients with lumbar single-level spinal stenosis or with (recurrent) disc herniation and concurrent degenerative disc disease and in 22 patients with an initially degenerated segment adjacent and superior to a fusion site. We prospectively obtained preoperative and postoperative (immediate, 6-, 12- and 24-month) clinical and radiographic evaluations; 37 of the 40 patients completed the 24-month followup. Using plain and extension-flexion radiographs, we compared implant failure rates and their association with postoperative implant translation, anterior and posterior disc height, and ROM for each configuration and between configurations. We assessed associations between clinical scores (VAS pain scores for back and leg, Oswestry Disability Index) and implant failure.

Results

Implant failure occurred in 10 of the 37 implants and corresponded to greater posterior disc height (single-level only) and implant translation. Adjacent-segment ROM increases and posterior disc height decreases over time were greater with the hybrid configuration. Implant failure rate related to higher Oswestry Disability Index (single-level only) and higher back pain scores.

Conclusions

Implant translation is associated with failure likely due to insufficient resistance to shear forces. Load transfer may cause progressive degeneration in the dynamic and adjacent segments, especially in the hybrid configuration.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Oswestry Disability Index Adjacent Segment Degenerative Disc Disease Posterior Lumbar Interbody Fusion Lordotic Angle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Cameron J. Wilson for proofreading and language checking of the article. Authors Eike Hoff and Patrick Strube have contributed equally to this work.

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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Eike Hoff
    • 1
    • 2
    Email author
  • Patrick Strube
    • 1
    • 2
  • Antonius Rohlmann
    • 1
  • Christian Groß
    • 1
  • Michael Putzier
    • 1
  1. 1.Center for Musculoskeletal Surgery and Julius Wolff Institute, Klinik für Orthopädie–Charité Campus MitteCharité–Universitätsmedizin BerlinBerlinGermany
  2. 2.Berlin-Brandenburg Center for Regenerative MedicineCharité–Universitätsmedizin BerlinBerlinGermany

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