Revision strategy and follow-up for implant failure in a case of combined anterior and posterior reconstruction after three-level en bloc vertebral body replacement and replacement of the aorta for chondrosarcoma of the thoracic spine

T. Graulich, C. Krettek, C. W. Müller

June 2019, Volume 28, Issue 2, pp 13 - 17 Case Report Read Full Article

First Online: 28 June 2018

Objective

In 2013, we reported a case of combined anterior and posterior reconstruction after three-level en bloc vertebral body replacement and replacement of the aorta for chondrosarcoma of the thoracic spine. Eight years after, we observed an implant failure and now report on revision strategy and 2-year follow-up (f/u) after revision.

Methods

We report about the 2-year f/u of the same now 51-year-old gravedigger who needed to undergo revision surgery after implant failure. We did a combined anterior and posterior correction vertebral interbody fusion by (1) removal of broken screws in Th9 and L2, removal of broken titanium bars, correction of kyphosis, enhancement of the vertebral interbody fusion from Th8 to L4 using monoaxial titanium screws and cancellous bone transplantation and (2) removal of the broken plate and the loose cage, implantation of a novel expandable PEEK cage from Th11 to L1 and anterior stabilization from Th9/10 to L2/3, as well as autologous and allogeneic cancellous bone transplantation.

Results

Two years after revision surgery, the patient presented fully reintegrated without any complains. No painkillers needed to be taken. Pain was reported with 2 out of 10 on the VAS.

Conclusion

Both procedures offer a good primary stabilization with excellent pain reduction and good return to life. Limited information on long-term survivors is known. Therefore, the theoretical advantage of a biological solution needs to be checked in the long-term f/u for consistency.

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