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Anterior column reconstruction of the thoracolumbar spine with a new modular PEEK vertebral body replacement device: retrospective clinical and radiologic cohort analysis of 48 cases with 1.7-years follow-up

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Abstract

Purpose

To evaluate whether a new PEEK vertebral body replacement can maintain the sagittal alignment as an anterior column reconstruction device in thoracic and lumbar spinal defects due to trauma or tumor.

Methods

Retrospective review of 48 patients who underwent a corpectomy between T5 and L5 due to trauma or tumor and were stabilized with the new PEEK vertebral body replacement, between 2013 and 2017. We excluded patients who underwent a corpectomy for infection or degenerative disease and patients without complete follow-up in our institution. The primary outcome was the bi-segmental kyphotic angle (BKA). Secondary outcomes were the assessment of pedicle screw loosening, cage height, and subsidence or tilting of the cage. The clinical outcomes were assessed through the COMI-Score, EuroQol-5D, and Karnofsky indexes. Bony fusion and complications were registered.

Results

After the surgery BKA decreased by 12.1° (p < 0.001). At the end of the follow-up, we observed a mean loss of reduction of 1.6° (p = 0.002). This was accompanied by an increase in subsidence of 2.1 mm (p < 0.001) and mean tilting of the cage of 1.4° (p = 0.003). The height of the cage and other parameters did not experience any changes.

Clinically, the COMI-Score (p = 0.02) and the EuroQol-5D Index (p = 0.012) showed significant improvement, same as Karnofsky-Index (p = 0.015) at final follow-up. The fusion rate according to Bridwell was 92.1%. The 2% late complications were related to implant malpositioning.

Conclusion

The new PEEK expandable vertebral body replacement is effective and safe in thoracic and lumbar anterior column reconstruction in tumor and trauma diseases.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 8, 3010, Bern, Switzerland

    M. C. Deml, C. A. Mazuret Sepulveda, C. E. Albers, S. Hoppe, S. F. Bigdon, S. Häckel, H. Milavec & L. M. Benneker

  2. Department of Orthopaedic and Trauma Surgery, Spine Team, Complejo Asistencial Dr. Sótero del Río, Puente Alto, Chile

    C. A. Mazuret Sepulveda

Authors
  1. M. C. Deml
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  2. C. A. Mazuret Sepulveda
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  3. C. E. Albers
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  4. S. Hoppe
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  5. S. F. Bigdon
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  6. S. Häckel
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  7. H. Milavec
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  8. L. M. Benneker
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MCD, CAM, CEA and SFB. The first draft of the manuscript was written by MCD and CAM and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to M. C. Deml.

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Conflict of interest

MCD and CEA received independent, peer-reviewed research grants from independent societies not related to that project. Therefore, all authors declare no conflicts of interest in the presented study.

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Deml, M.C., Mazuret Sepulveda, C. ., Albers, C.E. et al. Anterior column reconstruction of the thoracolumbar spine with a new modular PEEK vertebral body replacement device: retrospective clinical and radiologic cohort analysis of 48 cases with 1.7-years follow-up. Eur Spine J 29, 3194–3202 (2020). https://doi.org/10.1007/s00586-020-06464-x

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