Failure of stabilization of the spine with XXXX . A retrospective analysis of twenty-four cases.

@entity1 @entity11379 @entity5 @entity2737 @entity51 @entity3677 @entity3 @entity130
Twenty-four @entity1 who had a major complication after attempted stabilization of the spine with @entity3677 were referred for treatment. The initial instability that necessitated stabilization was caused by a traumatic condition in fifteen of these @entity1 and by a @entity3 in nine. The average length of time before failure of fixation was 208.3 days for the @entity1 who had a traumatic condition and 193.7 days for those who had a @entity5 . In eleven @entity1 a progressive @entity51 developed postoperatively, and in six others the recovery of neural function was possibly hindered by the cement. A @entity2737 developed in six @entity1 , and in five of them treatment by removal of the @entity3677 and metal, followed by a prolonged period of cervical traction, was required. Loosening and failure of fixation was the most common complication--it occurred in twelve of the fifteen @entity1 who had a traumatic lesion and in eight of the nine who had a @entity5 . Salvage operations that included removal of the cement and conventional bone-grafting procedures were performed in eleven of the twelve @entity1 who had loosening associated with a traumatic lesion and in six of the eight who had loosening and a @entity5 . Stability was restored in every @entity1 . Improved long-term results can be achieved by using grafts of iliac bone and triple-wire stabilization methods (a midline wiring between the spinous processes and two iliac-crest grafts, one on each side, wired to the posterior elements) instead of @entity11379 in the primary treatment of @entity130 . The treatment of choice for instability caused by neoplastic destruction of two or more vertebral bodies includes a construct of @entity3677 anteriorly. However, if cement is used, early augmentation with posterior fusion of the spine and stabilization should be considered. As a rule, combined anterior and posterior stabilization is recommended for the reconstruction of a spine that is unstable due to neoplastic destruction. In general, whenever @entity3677 is used for spinal stabilization, it should be augmented with grafts of iliac bone to provide long-term stability.
