OBJECTIVE: This study investigated the incidence and risk factors of rod fracture (RF) after multiple-rod constructs (MRCs) for adult spinal deformity (ASD) surgery. METHODS: A single-center, single-surgeon consecutive series of adult patients who underwent posterior thoracolumbar fusion at 4 or more levels using MRCs after osteotomy with at least 1 year of follow-up were retrospectively reviewed. Patient characteristics, radiological parameters, operative data, and clinical outcomes (on the Scoliosis Research Society-22r questionnaire) were analyzed at baseline and follow-up. RESULTS: Seventy-six patients were enrolled in this study. RF occurred in 9 patients (11.8%), with all cases involving partial rod breakage. Seven patients (9.2%) underwent revision surgery. There were no significant differences in baseline demographic characteristics, radiological parameters, and surgical factors between the RF and non-RF groups. Multivariable analysis revealed that interbody fusion at the L5-S1 and L4-S1 levels could significantly reduce the occurrence of RF after MRCs for ASD (adjusted odds ratios 0.070 and 0.035, respectively). The RF group had significantly worse function score (mean 2.9 ± 0.8 vs 3.5 ± 0.7) and pain score (mean 2.8 ± 1.0 vs 3.5 ± 0.8) compared with the non-RF group at last visit. CONCLUSIONS: RF occurred in 11.8% of patients with MRCs after ASD surgery. Most RFs occurred at the lumbosacral junction or adjacent level (77%). Interbody fusion at the lumbosacral junction (L5-S1 or L4-S1 level) could significantly prevent the occurrence of RF after MRCs for ASD.
OBJECTIVE: This study investigated the incidence and risk factors of rod fracture (RF) after multiple-rod constructs (MRCs) for adult spinal deformity (ASD) surgery. METHODS: A single-center, single-surgeon consecutive series of adult patients who underwent posterior thoracolumbar fusion at 4 or more levels using MRCs after osteotomy with at least 1 year of follow-up were retrospectively reviewed. Patient characteristics, radiological parameters, operative data, and clinical outcomes (on the Scoliosis Research Society-22r questionnaire) were analyzed at baseline and follow-up. RESULTS: Seventy-six patients were enrolled in this study. RF occurred in 9 patients (11.8%), with all cases involving partial rod breakage. Seven patients (9.2%) underwent revision surgery. There were no significant differences in baseline demographic characteristics, radiological parameters, and surgical factors between the RF and non-RF groups. Multivariable analysis revealed that interbody fusion at the L5-S1 and L4-S1 levels could significantly reduce the occurrence of RF after MRCs for ASD (adjusted odds ratios 0.070 and 0.035, respectively). The RF group had significantly worse function score (mean 2.9 ± 0.8 vs 3.5 ± 0.7) and pain score (mean 2.8 ± 1.0 vs 3.5 ± 0.8) compared with the non-RF group at last visit. CONCLUSIONS: RF occurred in 11.8% of patients with MRCs after ASD surgery. Most RFs occurred at the lumbosacral junction or adjacent level (77%). Interbody fusion at the lumbosacral junction (L5-S1 or L4-S1 level) could significantly prevent the occurrence of RF after MRCs for ASD.
Entities:
Keywords:
3-CO = 3-column osteotomy; ASD = adult spinal deformity; BMD = bone mineral density; BMP = bone morphogenetic protein; CI = confidence interval; LIV = lower instrumented vertebra; LL = lumbar lordosis; MRC = multiple-rod construct; OR = odds ratio; PCO = posterior column osteotomy; PI = pelvic incidence; PT = pelvic tilt; RF = rod fracture; SRS-22r = Scoliosis Research Society-22r questionnaire; SVA = sagittal vertical axis; UIV = upper instrumented vertebra; adult spinal deformity; interbody fusion; lumbosacral junction; multiple-rod constructs; rod fracture
Authors: Hani Chanbour; Steven G Roth; Matthew E LaBarge; Anthony M Steinle; Jeffrey Hills; Amir M Abtahi; Byron F Stephens; Scott L Zuckerman Journal: Spine Deform Date: 2022-09-05