Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors, and impact on health-related quality of life in 526 patients

Lertudomphonwanit, Thamrong; Kelly, Michael P.; Bridwell, Keith H.; Lenke, Lawrence G.; McAnany, Steven J.; Punyarat, Prachya; Bryan, Timothy P.; Buchowski, Jacob M.; Zebala, Lukas P.; Sides, Brenda; Steger-May, Karen; Gupta, Munish C.

doi:10.1016/j.spinee.2018.02.008

Cited by 68 publications

(59 citation statements)

References 28 publications

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“…Therefore, the follow-up period was different between the two-rod and multi-rod groups. Lertudomphonwanit et al [6] investigated 526 patients who underwent corrective fusion surgery for ASD and reported that rod fracture occurred in 97 patients (18.4%). Among them, approximately 50% of rod fractures occurred more than 3 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

et al. 2019

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Study Design A retrospective study. Purpose To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). Overview of Literature Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. Methods Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. Results Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. Conclusions The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.

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Section: Discussionmentioning

confidence: 99%

“…Rod breakage is the most serious implant-related complication that leads to severe back pain, loss of correction, and need for revision surgery in most cases [5,6]. We previously reported 54 cases of rod fracture (18%) after corrective fusion surgery in 304 ASD patients, 36 (66.7%) of whom required revision surgery [7].…”

Section: Introductionmentioning

confidence: 99%

Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

et al. 2019

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“…Lertudomphonwanit et al [7] проанализировали частоту переломов стержней у взрослых пациентов после операции дорсального спондилодеза протяженностью до крестца. Всего было 526 больных в возрасте 18-80 лет (в среднем 56,8 года), средний срок наблюдения -57 мес.…”

Section: рисunclassified

“…Не менее важными мы считаем результаты анкетирования пациентов, перенесших осложнение и повторную операцию (перемонтаж стержня), поскольку они показывают, что качество жизни, связанное со здоровьем, у этих больных снижается несущественно. Наши данные отличаются от результатов Lertudomphonwanit et al [7], и это различие мы склонны объяснить тем обстоятельством, что средний возраст обследованных ими пациентов составил почти 58 лет, в то время как в нашей когорте подавляющее большинство пациентов оперировано в возрасте 10-30 лет. Логично предположить, что молодым проще адаптироваться к усложняющимся условиям жизни, в том числе к последствиям перенесенного осложнения.…”

Section: рисunclassified

“…В хирургии деформаций позвоночника существует ряд специфических вертебрологических осложнений, в число которых входят те, которые непосредственно связаны с металлоимплантатом: переломы стержней и шурупов, спонтанный демонтаж конструкции, смещение ее элементов, повреждение опорных костных структур, выстояние металлоимплантата под кожу. Переломам стержней эндокорректора как самостоятельной проблеме посвящен целый ряд публикаций [1][2][3][4][5][6][7][8], однако при кажущейся многочисленности в них практически отсутствует информация о том, как влияет осложнение на конечный результат лечения с позиции качества жизни. Именно аспект качества жизни пациентов представляется нам приоритетным для оценки отдаленного результата, а не только лучевые данные потери коррекции деформации позвоночника в трех плоскостях.…”

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Does a fracture of the endocorrector rod affect the quality of life of a patient with spinal deformity?

2019

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Objective. To assess the effect of endocorrector rod fractures on the final result of treatment and the quality of life of patients operated on for spinal deformities of different etiology. Material and Methods. The study included 3833 patients older than 10 years who were operated on for spinal deformities of various etiologies and had not been subjected to spinal surgery before admission to the clinic. In the pre-and postoperative periods, spondylograms in frontal and lateral projections in the standing position were studied using the Cobb method, the apical vertebra rotation was determined in accordance with the method of Sullivan et al. Patients answered questions of the SRS-24 questionnaire in the immediate and long-term follow-up periods. Results. In total, fractures of metal implant rods were detected in 85 (2.2 %) patients. The average scoliotic deformity in these patients was 84.5° before surgery, 49.9° after surgery, and 53.7° at the end of the follow-up period (postoperative progression was 3.8°). Thoracic kyphosis was 61.5° before surgery, 44.3° after surgery, and 48.7° at the end of the follow-up period; lumbar lordosis-68.4°, 54.8°, and 56.5°; and apical vertebra rotation-55.8°, 33.2° and 35.8°, respectively. According to the questionnaire data, patients estimated their appearance after surgery and general appearance somewhat lower and pain as less intense. Indicators of activity and function of the spine after the rod remounting were slightly lower than after the primary surgery. Remounting did not significantly affect the indicator of "consent to surgical treatment under the same conditions"-80.6 and 80.0 %. Цель исследования. Оценка влияния переломов стержней эндокорректора на конечный результат лечения и качество жизни пациентов, оперированных по поводу деформаций позвоночника различной этиологии. Материал и методы. В исследование включены 3833 пациента от 11 до 50 лет, оперированные по поводу деформаций позвоночника различной этиологии, которые не подвергались операциям на позвоночнике до поступления в клинику. В до-и послеоперационном периодах исследовали спондилограммы в прямой и боковой проекциях в положении пациента стоя с использованием метода Cobb, ротацию апикального позвонка определяли по Sullivan et al. В ближайшем и отдаленном послеоперационном периодах пациенты отвечали на вопросы анкеты SRS-24. Результаты. В общей сложности переломы стержней металлоимплантатов были выявлены у 85 (2,2 %) больных. Средняя величина сколиотической деформации у этих пациентов до операции-84,5°, после операции-49,9°, в конце периода наблюдения-53,7°

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Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation

et al. 2020

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Purpose This in vitro biomechanical study compares residual lumbar range of motion (ROM) and rod strain after lumbopelvic instrumentation using 2 rods, 4 rods and interbody cages. Methods Seven human cadaveric specimens were instrumented from L1 to sacrum, and pelvic screws were implanted. The pelvis was constrained and moments up to 7.5 Nm were applied to T12. Segmental L1-S1 ROM was analyzed by tracking radiopaque balls implanted in each vertebra using biplanar radiographs. Deformation within principal rods was measured by strain gauges. Four configurations were compared: 2 rods (2R), 4 rods (4R), 4 rods + ALIF at L4-L5 and L5-S1 (4R + ALIF), 2 rods + ALIF (2R + ALIF). Results Intact average global L1-S1 ROM was 42.9° (27.9°-66.0°) in flexion-extension (FE), 35.2° (26.8°-51.8°) in lateral bending (LB), 18.6° (6.7°-47.8°) in axial rotation (AR). In FE, average ROM was 1.9° with both 4-rod configurations versus 2.5° with 2R and 2.8° with 2R + ALIF (p < 0.05). In LB, ROM ranged between 1.2° and 1.5° without significant differences. In AR, ROM was 2.5° with both 4-rod configurations versus 2.9° with 2R (p = 0.07) and 3.1° with 2R ALIF (p = 0.01). In FE, strain decreased by 64% and 65% in principal rods at L3-L4 with 4-rod. When comparing 2-rod configurations, strain decreased by 1% in flexion and increased by 22% in extension at L3-L4 when adding an ALIF at L4-L5 and L5-S1. Conclusions Double rods and interbody cages decrease residual ROM in FE and AT. Double rods seem efficient in limiting strain in principal rods. The use of single rods with cages at the lumbosacral junction increases strain at the first adjacent level without cage.

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Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors, and impact on health-related quality of life in 526 patients

Cited by 68 publications

References 28 publications

Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

Does a fracture of the endocorrector rod affect the quality of life of a patient with spinal deformity?

Influence of double rods and interbody cages on quasistatic range of motion of the spine after lumbopelvic instrumentation

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