gms | German Medical Science

Objective: Cachectic patients with a body mass index (BMI) of less than 17 (mild to severe underweight) because of individual constitution, chronic inflammatoric desease, HIV or malignant tumor history are more sensitive for complications after dorsal instrumentation concerning woundhealing and postoperative infections. Our aim in this retrospective data analysis was to show the benefit of low profile screws for stabilization in that patient population.

Method: We did an retrospective data analysis within a time period of one year of all patients with tumor pathology, spondylodiscitis and instabil spinal stenosis for dorsal instrumentation, concomitant BMI of less than 17. Low profile screws were used and performed by MESA System (K2M, USA) featuring dual locking tapers to lock the rod to the screw.

Results: 21 patients in a cachectic constitution were operated with MESA System: 8 patients with instabil spondylodiscitis in thoracic spine, 11 patients with tumor pathology in lumbar and thoracic column, one HIV-positive patient in clinical stadium II and one with drug abuse and spondyloptosis. 18/21 showed no woundhealing complication after instrumentation, only one after third surgery and two with small wound dehiscence after CSF leakage. There were no further wound infections or increase in morbidity due to recurrent surgery or prolonged wound healing. All patients' subjective assessment was no painful pressure feeling in musculature of the back. Furthermore, there were no mechanical failures or screw loosening at polyaxial head-rod junction or loss of correction.

Conclusions: Low profile screws could offer a benefit for instrumentation in cachectic patients, especially affecting woundhealing complications and subjective patients' feeling. Further, they provide good stability to the spine.