Removal of infected bone in-growth pelvic fixation implants and microcomputed tomography analysis of osseous integration: illustrative case

Bradley S. Spence, Matthew W Godlewski, Jason J. Haselhuhn, Kristen E Jones, David W. Polly

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND A novel pelvic fixation screw fusion device (iFuse Bedrock Granite implant) was designed to promote bony fusion through self-harvesting fenestrations throughout the outer screw shank. Bone on-growth and in-growth using this design have been demonstrated in a sheep model, but data from human subjects have not been reported. A 66-year-old medically complex female with 2 prior spine fusions developed spondylodiscitis cephalad to a prior fusion, requiring the removal of instrumentation, which included screw fusion devices. OBSERVATIONS Within this case report, the authors present a novel bone-preserving technique for the removal of well-fixed screw fusion devices. One screw backed out with a driver, and the other 3 had to be trephined out. One screw sheared off the T30 torque driver, implying a removal torque greater than 270 inch-lbs (30.5 Nm). In addition, the removed implants were analyzed using microcomputed tomography (micro-CT) and demonstrated bone on-growth, in-growth, and through-growth in all 4 screws. LESSONS Micro-CT clearly demonstrated osseous integration of the screw fusion devices and provided significant support for the use of these implants for lumbopelvic fixation. The authors’ hope is that the novel bone-preserving technique will help other surgeons when faced with the difficult removal of well-fixed screw fusion devices.

Original languageEnglish (US)
Article numberCASE24274
JournalJournal of Neurosurgery: Case Lessons
Volume8
Issue number8
DOIs
StatePublished - Aug 2024

Bibliographical note

Publisher Copyright:
© 2024 The authors.

Keywords

  • iFuse Bedrock Granite
  • infection
  • osseous integration
  • spondylodiscitis
  • technique

PubMed: MeSH publication types

  • Journal Article

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