Gregory M Mundis1, Corey T Walker2, Justin S Smith3, Thomas J Buell4, Renaud Lafage5, Christopher I Shaffrey4, Robert K Eastlack1, David O Okonkwo6, Shay Bess7, Virginie Lafage5, Juan S Uribe8, Lawrence G Lenke9, Christopher P Ames10. 1. Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA. 2. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. 3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. 4. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA. 5. Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY, USA. 6. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 7. Rocky Mountain Scoliosis and Spine Center, Denver, CO, USA. 8. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA. Neuropub@barrowneuro.org. 9. Department of Orthopedic Surgery, Columbia University, The Spine Hospital, New York, NY, USA. 10. Department of Neurosurgery, University of California, San Francisco Medical Center, San Francisco, CA, USA.
Abstract
PURPOSE: Coronal malalignment (CM) is a challenging spinal deformity to treat. The kickstand rod (KR) technique is powerful for correcting truncal shift. This study tested the hypothesis that the KR technique provides superior coronal alignment correction in adult deformity compared with traditional rod techniques. METHODS: A retrospective evaluation of a prospectively collected multicenter database was performed. A 2:1 matched cohort of non-KR accessory rod and KR patients was planned based on preoperative coronal balance distance (CBD) and a vector of global shift. Patients were subgrouped according to CM classification with a 30-mm CBD threshold defining CM, and comparisons of surgical and clinical outcomes among groups was performed. RESULTS: Twenty-one patients with preoperative CM treated with a KR were matched to 36 controls. KR-treated patients had improved CBD compared with controls (18 vs. 35 mm, P < 0.01). The postoperative CBD did not result in clinical differences between groups in patient-reported outcomes (P ≥ 0.09). Eight (38%) of 21 KR patients and 12 (33%) of 36 control patients with preoperative CM had persistent postoperative CM (P = 0.72). CM class did not significantly affect the likelihood of treatment failure (postoperative CBD > 30 mm) in the KR cohort (P = 0.70), the control cohort (P = 0.35), or the overall population (P = 0.31). CONCLUSIONS: Application of the KR technique to coronal spinal deformity in adults allows for successful treatment of CM. Compared to traditional rod techniques, the use of KRs did not improve clinical outcome measures 1 year after spinal deformity surgery but was associated with better postoperative coronal alignment.
PURPOSE: Coronal malalignment (CM) is a challenging spinal deformity to treat. The kickstand rod (KR) technique is powerful for correcting truncal shift. This study tested the hypothesis that the KR technique provides superior coronal alignment correction in adult deformity compared with traditional rod techniques. METHODS: A retrospective evaluation of a prospectively collected multicenter database was performed. A 2:1 matched cohort of non-KR accessory rod and KR patients was planned based on preoperative coronal balance distance (CBD) and a vector of global shift. Patients were subgrouped according to CM classification with a 30-mm CBD threshold defining CM, and comparisons of surgical and clinical outcomes among groups was performed. RESULTS: Twenty-one patients with preoperative CM treated with a KR were matched to 36 controls. KR-treated patients had improved CBD compared with controls (18 vs. 35 mm, P < 0.01). The postoperative CBD did not result in clinical differences between groups in patient-reported outcomes (P ≥ 0.09). Eight (38%) of 21 KR patients and 12 (33%) of 36 control patients with preoperative CM had persistent postoperative CM (P = 0.72). CM class did not significantly affect the likelihood of treatment failure (postoperative CBD > 30 mm) in the KR cohort (P = 0.70), the control cohort (P = 0.35), or the overall population (P = 0.31). CONCLUSIONS: Application of the KR technique to coronal spinal deformity in adults allows for successful treatment of CM. Compared to traditional rod techniques, the use of KRs did not improve clinical outcome measures 1 year after spinal deformity surgery but was associated with better postoperative coronal alignment.
Authors: Emily K Miller; Brian J Neuman; Amit Jain; Alan H Daniels; Tamir Ailon; Daniel M Sciubba; Khaled M Kebaish; Virginie Lafage; Justin K Scheer; Justin S Smith; Shay Bess; Christopher I Shaffrey; Christopher P Ames Journal: Neurosurg Focus Date: 2017-12 Impact factor: 4.047
Authors: Andrea Redaelli; Francesco Langella; Michal Dziubak; Riccardo Cecchinato; Marco Damilano; Giuseppe Peretti; Pedro Berjano; Claudio Lamartina Journal: Eur Spine J Date: 2020-01-06 Impact factor: 3.134
Authors: Ho-Joong Kim; Scott L Zuckerman; Meghan Cerpa; Jin S Yeom; Ronald A Lehman; Lawrence G Lenke Journal: Clin Spine Surg Date: 2021-12-01 Impact factor: 1.876