The use of three rods in correcting severe scoliosis

Rocos, Brett; Rioux-Trottier, Eliane; Machida, Masayoshi; Sigal, Amit; Kennedy, Jim; Lebel, David E; Zeller, Reinhard

doi:10.1007/s43390-021-00300-y

Cited by 3 publications

(15 citation statements)

References 31 publications

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“…Rocos et al 9 showed that the 3R technique is associated with a low risk of complication, with a single incidence of superior mesenteric artery syndrome and a single urinary tract infection. These data from this study show a complication rate of 4/21 (19%) due to delayed soft tissue healing or superficial infection.…”

Section: Discussionmentioning

confidence: 99%

“…The 3R group was treated with a 3R technique by a single surgeon (Figure 1). 9 After recording baseline evoked potentials, perioperative skeletal traction and exposure, anchors for the short rod are placed at the concave apex of the curve. Often, these are hooks because of the small size of the pedicles at the apex of the curve.…”

Section: Methodsmentioning

confidence: 99%

“…Alongside 2R constructs with or without osteotomy, these include preoperative halogravity traction (HGT), three-column osteotomy, anterior release and posterior fusion, and three-rod (3R) constructs, each with their relative merits and disadvantages. [6][7][8][9] Pre-operative HGT comes with a 1% risk of neurological complications, and three-column osteotomy with an high of independent post-operative neurological complication when compared to 2R posterior instrumented fusion alone (odds ratio (OR) = 1.7, 95% confidence interval (CI) = 1.11-2.85, p = 0.015). 6,7 Anterior release followed by posterior fusion has historically been commonplace, however, has fallen from favor as the correction achieved has been shown to be comparable to posterior correction alone.…”

Section: Introductionmentioning

confidence: 99%

“…10 The 3R technique was first described by Cotrel 11 and uses the sequential application of two rods to the concavity of the coronal deformity to create a corrective distraction before applying a stabilizing rod on the convexity. Recent work by Rocos et al 9 has shown that it is able to safely and effectively correct severe, stiff deformities. The technique has several possible advantages over 2R constructs including a stiffer construct and the option to partially release the sequential correction in response to neuromonitoring deterioration.…”

Section: Introductionmentioning

confidence: 99%

“…The technique has several possible advantages over 2R constructs including a stiffer construct and the option to partially release the sequential correction in response to neuromonitoring deterioration. 9,12 The risks and effectiveness of both three-column osteotomy and HGT have been defined relative to 2R constructs, however, no such comparison has been made between 2R and 3R. 7,[13][14][15] In this study, we compare the radiographic results of these techniques and the complications associated with their use.…”

Section: Introductionmentioning

confidence: 99%

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A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis

Machida

Rocos

Zeller

et al. 2023

Journal of Children's Orthopaedics

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Purpose: Managing severe scoliosis is challenging and risky with a significant complication rate regardless of treatment strategy. In this retrospective comparative study, we report our results using a three-rod compared to two-rod construct in the surgical treatment of severe spine deformities to investigate which technique is safer, and which provides superior radiological outcomes. Methods: Forty-six consecutive patients undergoing posterior spine fusion for scoliosis between 2006 and 2017 were identified in our institutional records. Inclusion criteria were minimum coronal deformity of 90°, age < 18 years at the time of surgery and a minimum 2 years of follow-up. Radiographic and clinical parameters, as well as post-operative complications were compared between the two groups. Results: There were 21 patients in the three-rod group and 25 in the two-rod group. The mean preoperative major coronal deformity was 100°± 9 and 102°± 10 in the three-rod and two-rod, respectively ( p = 0.6). The average major curve correction was 51% and 59% in three-rod and two-rod groups, respectively ( p = 0.03). The post-operative thoracic kyphosis was 30°± 11 and 21°± 12 in the three-rod and the two-rod groups, respectively ( p = 0.01). The surgical time was 476 ± 52 and 387 ± 84 min in three-rod and two-rod, respectively ( p < 0.01). One patient in the two-rod cohort showed permanent post-operative sensory deficit. There were three unplanned returns to operating theater in the two-rod group. Conclusions: Coronal correction was better with two-rod, whereas sagittal balance was superior with three-rod. Both techniques achieved balanced spine treating severe scoliosis. The two-rod technique was associated with a higher likelihood of requiring revision surgery. Level of evidence: level 3.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis

Machida

Rocos

Zeller

et al. 2023

Journal of Children's Orthopaedics

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Implant-Related Complications after Spinal Fusion: A Multicenter Study

Koshimizu

Nakashima

Ohara

et al. 2022

Global Spine Journal

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Study Design Retrospective analysis of prospectively database Objective Implant-related complications are an extremely important issue because they pose a burden to patients who underwent surgery. An understanding of these complications can help improve the postoperative management of patients undergoing spinal surgery. The current large-scale multicenter study aimed to identify postoperative implant-related complications that may require revision surgery. Methods In total, 3447 patients who underwent spinal fusion surgery were included in the analysis. Data about age at surgery, sex, preoperative diagnosis, surgical level, type of implant-related complications, causes of reoperation, and time from the initial to revision surgery were reviewed. Moreover, the characteristics of reoperation in 3 periods (within 30, 31–90, and over 90 days) were assessed. Result The overall incidence of implant-related complications was 4.6%. Adult spinal deformity was the most common diagnosis (9.9%), and thoracic-lumbar-sacral (42.9%) was the most common surgical level among patients with implant-related complications. Further, screw malposition was the most frequent implant-related complication (42.8%). In total, 89 (2.6%) patients underwent reoperation due to implant-related complications. The main causes of reoperation within 30, 31–90, and over 90 days were screw malposition (72.2%), screw loosening or pull out (81.8%), and rod or screw fracture (60.9%), respectively. Conclusion To the best of our knowledge, this was the first large-scale multicenter study that assessed the characteristics of patients who underwent reoperation due to spinal implant-related complications. The study results could improve the preoperative informed consent procedure about spinal fusion.

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Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up

Zhang,

Deng,

Guo

et al. 2023

J Orthop Surg Res

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Background Many patients with neuromuscular scoliosis (NMS) experience a variety of difficult medical problems that aggravate the development effects of progressive scoliosis and pelvic obliquity (PO). The objective of the current study was to assess the safety and effectiveness of multi-rod posterior correction only (MRPCO) with halo-femoral traction (HFT) for the management of adult NMS (> 100°) with severe PO. Methods From 2012 to 2017, 13 adult patients who suffered from NMS (> 100°) with severe PO underwent MRPCO with HFT. The radiography parameters in a sitting position, such as the coronal Cobb angle of the main curve, the PO and the trunk shift (TS), were measured at the preoperative, postoperative and final follow-up stages. The preoperative and final follow-up assessment of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was taken. Results The average follow-up span was 68.15 ± 6.78 months. There was decreased postoperative coronal Cobb angle with an average mean of 125.24° ± 11.78° to 47.55° ± 12.10°, with a correction rate of 62.43%; the PO was reduced to 6.25° ± 1.63° from 36.93° ± 4.25° with a correction rate of 83.07%; the TS was reduced to 2.41 cm ± 1.40 cm from 9.19 cm ± 3.07 cm. There was significant improvement in all parameters compared to the preoperative data. The VAS score reduced from 4.77 ± 0.93 to 0.69 ± 0.75, and the ODI score reduced from 65.38 ± 16.80 to 28.62 ± 12.29 at the final follow-up. Conclusions Treatment of adult NMS (> 100°) with severe PO could be safe and effective with MRPCO with HFT. In order to obtain the optimum sitting balance, this could reduce the prevalence of complications and rectify the curvature and the correction of PO.

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The use of three rods in correcting severe scoliosis

Cited by 3 publications

References 31 publications

A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis

A comparison of three- and two-rod constructs in the correction of severe pediatric scoliosis

Implant-Related Complications after Spinal Fusion: A Multicenter Study

Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up

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