Dɔnɔdzikpɔƒe ƒe Nudzɔdzɔ Ŋuti Numekuku: Dzikpɔkpɔ Seveve Cephalad Migration of Spinal Fusion Rod yi The Thoracic Cavity To Zero-Tolerance Fixation

Kɔdzi: Kɔdzi Universitario San Ignacio, Bogotá, Colombia
Amekola: Ðɔkta Mateo Restrepo, Department of Complex Spine Reconstruction
Ɣletiŋkeke: October 2025
Dɔlélea ƒe hatsotso: Catastrophic Hardware Migration / Revision Posterior Spinal Instrumentation
Emetsonu vevitɔ: Legary rod si ʋu ƒe megbe ɖeɖe tso akɔta ƒe liƒo dzi le afɔɖeɖe ɖeka me, eye woatsɔ xɔtuɖoɖoa ƒe ŋusẽdodo blibo akplɔe ɖo XC Medico® Premium Polyaxial Dɔwɔɖoɖo. Dɔwɔwɔ ƒe ɣeyiɣi bliboa: Aɖabaƒoƒo 155. Dɔnɔ si woƒo ƒu dedie le dɔwɔwɔ nɛ vɔ megbe ŋkeke 2 lia dzi.

Nya la Gbɔgblɔ

Dɔnɔwo ƒe Amewo ƒe Agbɔsɔsɔ Kple Dɔnɔdzikpɔƒe Ŋutinya

• Dɔnɔ: Carlos Mendoza (womeyɔ eƒe ŋkɔ o)
• Ƒe si wòxɔ: Ƒe 52
• Ŋutsu alo nyɔnu nyenye: Ŋutsu
• Dɔléle gbãtɔ si wokpɔna: Ƒewuiviwo ƒe akɔta ƒe ʋuka me dɔléle sesẽ aɖe
• Amekoko ŋutinya: Megbe akɔta ƒe nɔnɔme madeamedzi ɖɔɖɔɖo kple fusion spanning T11-L3 si wowɔ ƒe 15 do ŋgɔ to domenyinu non-locking pedicle screw system zazã me.
• Dɔwɔwɔ vɔ megbe ƒe nusɔsrɔ̃: Dzesi aɖeke mele eŋu o eye woɖɔ eƒe xɔtunuwo ɖo bliboe eye wotsɔ agbenɔnɔ ƒe ƒoƒo ɖekae bliboe ƒe ewo kple edzivɔ.
• Dɔléle siwo kpe ɖe eŋu: Ʋusɔgbɔdɔ si nu mesẽ o (si dzi wokpɔna), atamanola veviedonula, ƒumeŋusẽ ƒe agbɔsɔsɔ si ɖee fia be ƒumeŋuɖui le kabakaba (T-score -1.8).

Nyatoƒoetoto Kple Dɔdaƒe ƒe Ɣeyiɣikɔntabubu Gbɔgblɔ

Nyatoƒoetoto vevitɔ: Akɔtave si mebɔ o, si le ɖaɖɛ le miame si klẽna ɖe abɔta, si gagblẽna ɖe edzi vivivi to gbɔgbɔ deto me, si kpe ɖe gbɔgbɔtsixetsixe si nu mesẽ o ŋu le kwasiɖa 3 me. Womeka nya ta be akɔtave le teƒe aɖe alo ahɔhɔ̃mekawo ƒe dɔmawɔmawɔ nyuie le eƒe afɔkpodzi ƒe akpa si le ete ŋu o.

Ɣeyiɣi ƒe ɖoɖo:

• Ŋkeke 1 (Woxɔe ɖe kɔdzi): Dɔnɔ si wotsɔ yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ le vɔvɔ̃ be dzitodzito alo aklã me nudzɔdzɔ kpata aɖe adze edzi ta. Electrocardiogram kple dzitodzito me enzymewo sɔ.
• Ðikeke: Hardware ƒe kuxi si dzea egɔme megbe alo paravertebral mass.
• Nɔnɔmetatawo ɖeɖe ƒe nu vevitɔ: STAT akɔta ƒe fotoɖeɖe kple akɔta ƒe CT scan si me kɔ nyuie si kplɔe ɖo si wobia le gaƒoƒo 3 me.

Nusiwo Wokpɔ le Nɔnɔmetatawo Me Kple Amekoko Ŋuti Ðoɖowɔwɔ

Radiographic & CT Nusiwo Wokpɔ (Nɔnɔmetata 1 & 2):

• Xɔtuɖoɖo ƒe nɔnɔme: Mɔ̃ɖaŋununya ƒe kpododonu blibo le miame T11-L3 atikplɔ-screw ƒe ƒomedodo. Miame flat set screws la trɔ megbe keŋkeŋ, si wɔe be wogbã xɔtuɖaŋu bliboa.
• Hardware translocation: Miame 5.5mm didime stabilization rod la ɖe eɖokui ɖa keŋkeŋ tso pedicle screw saddles. Esi ƒe geɖe ƒe akɔta ƒe ƒoƒo atraɖii kple eƒe tɔtrɔ ƒe tsatsam ʋã atikplɔ si ŋu womexe mɔ ɖo o la, eʋu yi dziƒo (cephalad) sentimeta geɖe.
• Ŋutilã ƒe dɔwɔwɔ ƒe nugbegblẽ: Ati si ʋu la ƒe nugbɔ si le etame la gbã paravertebral fascial planes, tso costovertebral liƒowo, eye wòge ɖe miame akɔta ƒe do me goglo, eye wòɖi ɖe eme le afisi te ɖe akɔta kple ʋuka gãwo ƒe akɔta ƒe mɔ gãwo ŋu enumake.

Amekoko Ŋuti Numedzodzro: Atikewɔwɔ Ŋuti Nyametsotso

Dɔdamɔnu ƒe nuwɔwɔ kpata: Ne wogblẽ titanium-ti si ŋu womexe mɔ ɖo o ɖe akɔta ƒe akpa si le ŋusẽ kpɔm la me la, enyea afɔku enumake be aortic laceration, intercostal vessel exeration, alo tension pneumothorax le ʋuʋu kpata me. Amekoko ƒe nuɖeɖe kpata kple eƒe wɔwɔme gbugbɔgaɖɔɖo nye sedziwɔwɔ.

Tiatia 1: Video-Assisted Thoracoscopic (VATS) Extraction Siwo Mebɔ O Ko

Nusiwo gblẽ le eŋu: Ne woɖe atikplɔa ɖa to akɔta ƒe mɔnu dzi kpɔa afɔku si le lãkusi me enumake gbɔ gake egblẽa akɔta ƒe akpa si meli ke o, si gbã la ɖi. Ne womegbugbɔ ŋku lé ɖe megbe ŋu o la, nuteɖeamedzi gã aɖe anɔ pedicle screws susɔeawo ŋu, si ana aseptic loosening kabakaba, akɔtave sesẽ, kple secondary deformity progression.

Tiatia 2: Thoraco-Abdominal kple Posterior Open Revision ƒe Ƒuƒoƒo

Nusiwo gblẽ le eŋu: Ne wowɔ lãɖeɖe vovovo eve (ŋgɔgbe akɔta ɖeɖe hena atikplɔ xɔxɔ kple megbe ʋuʋu mɔnu hena akɔta ƒe liƒo) le ŋkeke geɖe me dzia dɔwɔwɔ ƒe ɣeyiɣi bliboa ɖe edzi va ɖoa miniti 320+. Mɔnu eve ƒe xɔtuɖaŋu sia doa ʋu ƒe sisi, aklã me kuxiwo, kple kɔdzi aba ƒe didime ɖe dzi ŋutɔ va ɖoa ŋkeke 6-8 ya teti.

Tiatia 3: Afɔɖeɖe Ðeka Megbe Retrograde Retrieval + Ŋusẽdodo Cross-Link Fixation (Tiatia) .

Mɔ̃ɖaŋununya ƒe mɔnu: Ne wogbugbɔ ʋu megbe titina fli si wotso tsã la na woate ŋu age ɖe xɔtunu ƒe aba susɔea dzi tẽ. Amekolaa zã aŋenu tɔxɛ siwo wotsɔ ɖea atikplɔae tsɔ kplɔ atikplɔa ƒe akpa si le megbe la ɖo megbe tso megbe, eye wòtsɔ ŋuɖɔɖɔɖo tsɔe do goe le akɔta ƒe doa me le fluoroscopic ƒe mɔfiame sesẽ te. Esia na woƒo asa na akɔta ɖeɖe le wo ɖokui si le ŋgɔgbe.

Esi woɖee vɔ la, wotsɔ XC Medico® Premium Polyaxial Pedicle Screw System ɖɔ li domenyinu ƒe ɖoɖo si meli ke o . Be woaɖe nusi gbɔ kpododonu gbãtɔa tso ɖa la, xɔ yeyea tsɔ dzogoe manyomanyo ƒe kpeɖodzinu siwo woɖona ƒe gavi siwo wotsɔ xea mɔ na ka ƒe kaka nu ƒu, tsɔ kpe ɖe atitsoga ƒe kadodo sesẽ siwo woate ŋu atrɔ asi le ŋu be woawɔ dzogoe ene me xɔtunu si womate ŋu aʋuʋu o.

Adzɔnuwo tiatia: XC Medico ƒe Premium Spinal Fixation System — ƒo ƒu kple high-torque polyaxial pedicle screws kple negative-dzogoe ɖoɖo screws kple sesẽ atrɔ asi le cross-links.

Amekoko ƒe Amewuwu: Amekoko Ŋuti Nyatakakawo

Ðoƒe Kple Wo Ðeɖe Ðe Go

• Dɔnɔ ƒe nɔnɔme: Nɔnɔme si woatsɔ abɔbɔ ɖe Relton-Hall ƒe xɔtunu si wozãna ɖaa dzi, si wɔnɛ be ƒodo ƒe ʋuʋu nyuie wu be woaɖe ʋukawo ƒe nyaƒoɖeamenu dzi akpɔtɔ.
• Nusiwo woɖe ɖe go: Woɖe abi si nɔ megbe ƒe titina fli si nɔ anyi tsã la ɖa. Wowɔ subperiosteal dissection nyuie be woaɖe domenyinu pedicle screws tso T11 va ɖo L3. Operative field exposure si wokpɔ le miniti 25 me.

Hardware Xɔxɔ Kple Thoracic Clearance Akpa

• Kukuɖenuŋu: Wokpɔ miame pedicle screw tulips la woʋu eye set screws mele wo ŋu kura o. Wode dzesi atikplɔ si ʋu la ƒe asike ƒe nuwuwu wòdo ɖe gota vie tso paravertebral lãmeka ƒe aba si te ɖe T11 ŋu.
• Eɖeɖe: Le axadzi fluoroscopic ŋkuléle ɖe eŋu atraɖii te la, wotsɔa aŋenu tɔxɛ siwo wotsɔ léa nu sesẽwo dea atikplɔa ƒe asike si woate ŋu akpɔ la ŋu. Wozã axial traction mɔnu si dzi wokpɔna, si nɔa anyi ɖaa tsɔ he atikplɔa yi megbe le eƒe ʋuʋu ƒe mɔ dzi.
• Clearance check: Woɖe atikplɔa nyuie evɔ womedo go tsitretsiɖeŋu o. Fluoroscopy kple lãkusi ƒe kekeɖenudɔwɔwɔ ƒe dodokpɔ enumake ɖo kpe edzi be aklã ƒe liƒoa gakpɔtɔ li eye aklã ƒe akɔta ƒe dɔléle sesẽ aɖeke menɔ eŋu o. Akpa ƒe didime: Aɖabaƒoƒo 40.

Gbugbɔgaɖɔɖo Fixation & Rigid Frame Kpekpe Akpa

• Screw exchange: Woɖe domenyinu screw siwo woɖe la ɖa. Woɖe ƒu ƒe akpa siwo le ƒunukpeƒewo eye wodzi woƒe lolome ɖe edzi be woate ŋu axɔ XC Medico® 6.0mm Premium Polyaxial Pedicle Screws, si na wokpɔ egbɔ be woƒle ƒu nyuie wu le ƒumeŋuɖui ƒe abawo me.
• Atikplɔ ƒe gaƒoɖokui: Wotsɔ titanium-ti ƒe atikplɔ yeye siwo ƒe didime nye 5.5mm siwo wotsɔ ƒo xlãe do ŋgɔ la nɔ anyi. Vevietɔ la, wotsɔ ʋukula siwo wodo kpɔ tsɔ torqued XC Medico ƒe reverse negative-angle set screws va ɖo 8 Nm. Ka ƒe nɔnɔmetata la he tulip ƒe gliawo yi eme vevie, si ɖe afɔku si le kekem la ɖa.
• Cross-link integration: Wotsɔ cross-connector sesẽ eve siwo woate ŋu atrɔ asi le la ɖo miame kple ɖusime atikplɔawo dzi le T12 kple L2 ƒe dzidzenuwo dzi. Esia trɔ atikplɔ eve siwo le wo ɖokui si wozu xɔtunu ɖeka si sesẽ ŋutɔ, si wɔe be atikplɔ si didi la mete ŋu ƒua du ŋutɔŋutɔ o. Akpa ƒe didime: Aɖabaƒoƒo 70.

Ðeɖekpɔkpɔ Mamlɛtɔ Kple Nuwuwu

Biplanar fluoroscopy mamlɛtɔ ɖo kpe screw ƒe goglome nyuitɔ, atikplɔ ƒe ɖoɖo si sɔ pɛpɛpɛ, kple ŋutilã ƒe wɔwɔme gbugbɔgaɖɔɖo dzi. Wode tsi teƒea nyuie, wotsɔ tsi si le lãmeka te ƒe tsidzɔƒe de eme, eye wowu fascial closure si me ƒuƒoƒo vovovowo le nu. Dɔwɔwɔ ƒe ɣeyiɣi bliboa: Aɖabaƒoƒo 155. Ʋu si wobu be wòabu: 210 mL. Dodo na ame: Zero.

Dɔwɔwɔ Le Dɔwɔwɔ Megbe Nusɔsrɔ̃ Kple Emetsonuwo

Dɔwɔwɔ vɔ megbe Enumake (POD 0-1) .

Dɔnɔa nyɔ esi akɔtave sesẽa nu tso enumake (VAS dzi ɖe kpɔtɔ tso 8/10 do ŋgɔ na dɔwɔwɔ nɛ va ɖo 2/10 le dɔwɔwɔ nɛ vɔ megbe). Woɖo kpe gbɔgbɔtsixe ƒe gbeɖiɖi siwo sɔ dzi le akpa evea siaa, si na be womegakpɔa aklãdɔ si tsi megbe o. Radiograph siwo woɖe le dɔwɔwɔ vɔ megbe ɖee fia be xɔtunu siwo mewɔ ɖeka kple wo nɔewo o le ɖoɖo nu. Kaka POD 1 naɖo la, dɔnɔa bɔbɔ nɔ abatia to nyuie eye eƒe abɔ kple afɔ ƒe ahɔhɔ̃mekawo ƒe dɔwɔwɔ bliboe.

Ðoɖowɔwɔ ɖe Tsiɖeɖe Ŋu (POD 2 — Gaƒoƒo 48) .

Le gaƒoƒo 48 le dɔwɔwɔ vɔ megbe la, woɖea tsi si le lãmeka te la ɖa (si me woɖea tsi le suetɔ kekeake). Dɔnɔa ɖo dɔnɔdzikpɔƒea ƒe dodokpɔ ƒe dzidzenuwo katã gbɔ: azɔlizɔzɔ le eɖokui si kple azɔlizɔzɔ si sɔ, nu me nono nyuie, kple vevesese dzi ɖuɖu to vevesesenutsitike siwo woano dzi. Ne woɖe asi le eŋu kaba le gaƒoƒo 48 me ɖe dɔlékui siwo woxɔna le kɔdzi ƒe afɔkua dzi kpɔtɔ eye wòɖe abadzivɔ siwo le dɔwɔƒewo dzi kpɔtɔ.

Dzesidede (Kwasiɖa 6 & Ɣleti 3) .

Le ɣleti 3 ƒe dzesia me la, vevesese aɖeke menɔ Carlos ŋu kura o (VAS 0/10) eye wòtrɔ yi dɔnyala ƒe dɔ siwo mesẽ o dzi. Akɔta kple aklã ƒe fotoɖeɖe siwo kplɔ wo nɔewo ɖo ɖo kpe edzi be micro-motion zero le screw-rod ƒe ƒoƒoƒewo. XC Medico® ƒe xɔtunu si wotsɔ ka ɖe wo nɔewo ŋu la lé xɔtuɖoɖo ƒe léle blibo me ɖe asi, eye ƒu sesẽwo ƒe fusion ƒe dzesi gbãtɔwo nɔ ƒoƒom ɖe akɔta ƒe akpawo katã.

Ganyawo me dzodzro: Afɔɖeɖe ɖeka ƒe gbugbɔgaɖɔɖo ƒe ɖoɖo vs afɔɖeɖe siwo wowɔ le gaglãgbe ƒe nudede nyawo

me Gazazã ƒe hatsotso	Afɔɖeɖe ƒe mɔnu geɖe me toto (Domenyinu)	Afɔɖeɖe ɖeka ƒe XC Medico® System (Nyateƒe)	Vovototo
Amekoko ƒe nusiwo wotsɔ dea ame me (Anterior/Thoracic tools) .	$9,800 (Toracoscopic melidzeƒewo, ɣeyiɣi kpui aɖe ƒe nuɖuɖu veviwo)	$0	-$9,800 ƒe home
Amekoko ƒe nusiwo wotsɔ dea ame me (Posterior Spinal Frame) .	$8,400 (Dzidzenu parallel atikplɔ & gavi)	$6,100 (XC Medico Premium Kplu & Atitsoga-kadodowo)	-$2,300 ƒe home
Dɔwɔwɔ ƒe ɣeyiɣi (Dɔwɔƒea ƒe fetu: $250/min)	$8,000 (aɖabaƒoƒo 320 le ŋkeke vovovowo me)	$3,875 (aɖabaƒoƒo 155 ƒe afɔɖeɖe ɖeka ƒe xɔxlɔ̃)	-$4,125 ƒe home
Amekola, Akɔtaŋutinunyala & Alɔ̃dɔdɔ ƒe fewo	$8,500 (fe siwo woxena ɖe ɖoɖo nu le ɖoɖo vovovowo nu) .	$4,800 (Ɣeyiɣi ɖeka ƒe megbewuwu ƒo ƒu)	-$3,700 ƒe home
Kɔdzi ƒe ICU/Ward nɔnɔ (Abati ƒe fetu: $450/ŋkeke)	$3,150 (ŋkeke 7 ƒe hayahaya le mama dedie nu na akɔta ƒe ʋuʋu ƒe gege ɖe eme)	$900 (ŋkeke 2 ƒe kpeɖodzinana be woaɖe asi le eŋu do ŋgɔ)	-$2,250 ƒe home
Dɔwɔwɔ vɔ megbe nɔnɔmetatawo & Aklã me dodokpɔwo	Dɔlar 2,400 ye	Dɔlar 2,175	-$225 ƒe home
GA SI WOTSƆ TƆTƆE KATÃ	Dɔlar 40,250 ye	Dɔlar 17,860 ye nye dɔlar 17,860	-$22,390 (55% dzi ɖe kpɔtɔ)

Le dɔwɔƒe si kpɔa akɔta ƒe nuveviwɔame kple nuwo gbugbɔgatu ƒe dɔwɔƒe si le domenyinu ƒe kpododonu sesẽwo dzi kpɔm gome la, XC Medico ƒe ʋuƒoƒo ƒe ɖoɖo siwo ƒe ŋusẽ lolo, siwo ƒe dzogoe manyomanyowo zazã naa habɔbɔa ƒe gadzadzraɖo si nye $22,390 USD le nya ɖesiaɖe me esime wòle dɔwɔwɔ ƒe asitɔtrɔ nyuitɔ dzi kpɔm eye wòɖea fe evelia siwo woxɔna le nudzɔdzɔ kpatawo me dzi kpɔtɔna.

Mɔ̃ɖaŋununya ƒe Nyabiasewo Kple Ŋuɖoɖowo na Gbugbɔgatu ƒe Ƒuƒoƒo Sesẽwo

Q: Aleke negative-angle buttress threads xea mɔ na set screw back-out ne wotsɔe sɔ kple standard flat threads?

A: Standard flat alo V-threads wɔa gota radial ŋusẽ ɖe screw ta (tulip) ƒe gli ememetɔwo ŋu ne wobla wo sesĩe va ɖo torque mamlɛtɔ. Le cyclic mechanical stress gã me la, radial force sia nana tulip gliwo kekena vie alo 'splay.' Ne spy nya dzɔ ko la, ka la ƒe kadodoa ɖiɖina, si wɔnɛ be set screw la gbugbɔna doa go. XC Medico ƒe negative-angle buttress thread la ɖea anyigba ƒe nɔnɔme si le anyime kple ememe fiana. Ne wozã torque la, ka ƒe ŋusẽwo hea tulip gliawo yia eme ŋutɔŋutɔ, si xea gavi si woɖo ɖi la ɖe atikplɔa ŋu sesĩe eye wòɖea xɔtuɖaŋu si splay-driven la ɖa keŋkeŋ.

Q: Nukatae wòle be woawɔ cross-link system le megbe ɖɔɖɔɖo siwo ƒe akpa didiwo me be woaxe mɔ ɖe atikplɔ ƒe ʋuʋu nu?

A: Ðeko atikplɔ siwo sɔ kple wo nɔewo siwo le wo ɖokui si nɔa te ɖe teƒea ƒe ʋuʋudedi si le pedicle screw ɖekaɖekawo ŋu dzi. Ne ƒu ƒe nɔnɔme si me ƒu le le dɔnɔ aɖe si la, akɔta ƒe tɔtrɔ enuenu ate ŋu ana nusuekpɔmɔ̃ natrɔ asi le gavi ƒe ta ŋu, si agblẽ nu le teƒea ƒe ʋuʋudedi ƒe nuléle ma ŋu le ɣeyiɣi aɖe megbe. Ne wotsɔ atitsoga ƒe kadodo siwo woate ŋu atrɔ asi le la awɔ tɔdzisasrã na miame kple ɖusime atikplɔawo woazu aɖaka ƒe xɔtunu sesẽ si le dzogoe ene me. Kadodo sia si le gbadzaƒe geɖe la tsɔa lãɖeɖe ƒe nuteɖeamedziwo yia xɔtunu bliboa me, si wɔnɛ be atikplɔ si le didiƒe ƒe ʋuʋu le eɖokui si mete ŋu ƒua du le mɔ̃ɖaŋununya me o nenye be gavi ɖeka ƒe ƒoƒo to micro-fretting ƒe vuvu me gɔ̃ hã.

Mamãlawo ƒe Asixɔxɔ ƒe Nyagbɔgblɔ: Nutoa me Dɔbiagbalẽviwo Dzi ɖuɖu

• Asitsatsa ƒe Nuwuwu: Mɔ̃ɖaŋununya ƒe egbɔkpɔnu si ɖea afɔku si le nuwo gbugbɔgawɔ me dzi kpɔtɔna eye wòɖea gazazã siwo katã ku ɖe dɔ vovovowo ŋu dzi kpɔtɔna 55% la tsɔtsɔ na kɔdzi ƒe nuƒlehawo ɖoa asitsatsa ƒe asixɔxɔ si ɖeke mesɔ kplii o anyi le dɔbiagbalẽviwo me toto me.
• Dɔnɔdzikpɔƒe ƒe Kakaɖedzi: Nana akɔtadɔdalawo kple ɖaseɖigbalẽ (ISO 13485) TC4 Titanium xɔtunu siwo me sub-micron mɔ̃wo ƒe mɔɖeɖewo le kpɔa egbɔ be kakaɖedzi le torque locking locking ŋu, si kpɔa woƒe habɔbɔ ƒe ŋkɔ ta tso xɔtutu ƒe kpododonu siwo le megbe me.