Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Abstract BACKGROUND Rigid internal fixation of the spine is an essential part of adult spinal deformity (ASD) surgery. Despite the use of pelvic fixation and anterior column support, spinopelvic fixation failure (SPFF) still remains an issue. Few studies have evaluated the types of such failure or its related factors. OBJECTIVE To classify the types of SPFF and investigate its risk factors, including the fusion status at L5-S1 on CT scan. METHODS The study cohort consisted of ninety-eight ASD patients who underwent more than 4-level fusions to the sacrum with interbody fusion at L5-S1. Patients with SPFF were divided into the two groups: above-S1 and below-S1 failure groups. The patient, surgical, and radiographic variables in each group were compared to those of the no-failure group. The L5-S1 fusion status was assessed using 2-yr computed tomography (CT) scan. Univariate and multivariate analyses were performed to determine the risk factors for each failure group. RESULTS The mean age was 68.5 yr. Follow-up duration was 55.7 mo. The SPFF developed in 46 (46.9%) patients at 32.7 mo postoperatively. There were 15 patients in the above-S1 failure group and 31 patients in the below-S1 failure group. Multivariate analysis revealed that nonunion at L5-S1 was a single risk factor for above-S1 failure. In contrast, the risk factors for below-S1 failure included a greater number of fused segments and postoperative less thoracic kyphosis. CONCLUSION SPFF develops in different patterns with different risk factors. Above-S1 SPFF was associated with nonunion at L5-S1, while below-S1 SPFF was associated with mechanical stress.

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Commentary: Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽

10.1093/neuros/nyaa489 ◽

2020 ◽

Author(s):

Lee A Tan

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Related Factors ◽

Spinopelvic Fixation ◽

Failure Types

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Dislocation rate and its risk factors in total hip arthroplasty with concurrent extensive spinal corrective fusion with pelvic fixation for adult spinal deformity

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-020-02764-6 ◽

2020 ◽

Author(s):

Hiroki Furuhashi ◽

Yu Yamato ◽

Hironobu Hoshino ◽

Yuta Shimizu ◽

Tomohiko Hasegawa ◽

...

Keyword(s):

Risk Factors ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Dislocation Rate ◽

Pelvic Fixation ◽

Total Hip

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182. Catastrophic acute failure of pelvic fixation in adult spinal deformity requiring revision surgery: a multicenter review of incidence, failure mechanisms, and risk factors

The Spine Journal ◽

10.1016/j.spinee.2021.05.389 ◽

2021 ◽

Vol 21 (9) ◽

pp. S92

Author(s):

Christopher T. Martin ◽

David W. Polly ◽

Kenneth Holton ◽

Benjamin D. Elder ◽

Jeremy L. Fogelson ◽

...

Keyword(s):

Risk Factors ◽

Spinal Deformity ◽

Revision Surgery ◽

Adult Spinal Deformity ◽

Failure Mechanisms ◽

Pelvic Fixation ◽

Acute Failure

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Commentary: Failure Types and Related Factors of Spinopelvic Fixation After Long Construct Fusion for Adult Spinal Deformity

Neurosurgery ◽

10.1093/neuros/nyaa516 ◽

2020 ◽

Author(s):

Mohit Patel ◽

Manish K Kasliwal

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Related Factors ◽

Spinopelvic Fixation ◽

Failure Types

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Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors

Journal of Neurosurgery Spine ◽

10.3171/2013.6.spine121129 ◽

2013 ◽

Vol 19 (4) ◽

pp. 445-453 ◽

Cited By ~ 48

Author(s):

Woojin Cho ◽

Jonathan R. Mason ◽

Justin S. Smith ◽

Adam L. Shimer ◽

Adam S. Wilson ◽

...

Keyword(s):

Risk Factors ◽

Failure Rate ◽

Spinal Deformity ◽

Interbody Fusion ◽

Adult Spinal Deformity ◽

Failure Group ◽

Lumbopelvic Fixation ◽

Iliac Screws ◽

Rod Breakage ◽

Anterior Column Support

Object Lumbopelvic fixation provides biomechanical support to the base of the long constructs used for adult spinal deformity. However, the failure rate of the lumbopelvic fixation and its risk factors are not well known. The authors' objective was to report the failure rate and risk factors for lumbopelvic fixation in long instrumented spinal fusion constructs performed for adult spinal deformity. Methods This retrospective review included 190 patients with adult spinal deformity who had long construct instrumentation (> 6 levels) with iliac screws. Patients' clinical and radiographic data were analyzed. The patients were divided into 2 groups: a failure group and a nonfailure group. A minimum 2-year follow-up was required for inclusion in the nonfailure group. In the failure group, all patients were included in the study regardless of whether the failure occurred before or after 2 years. In both groups, the patients who needed a revision for causes other than lumbopelvic fixation (for example, proximal junctional kyphosis) were also excluded. Failures were defined as major and minor. Major failures included rod breakage between L-4 and S-1, failure of S-1 screws (breakage, halo formation, or pullout), and prominent iliac screws requiring removal. Minor failures included rod breakage between S-1 and iliac screws and failure of iliac screws. Minor failures did not require revision surgery. Multiple clinical and radiographic values were compared between major failures and nonfailures. Results Of 190 patients, 67 patients met inclusion criteria and were enrolled in the study. The overall failure rate was 34.3%; 8 patients had major failure (11.9%) and 15 had minor failure (22.4%). Major failure occurred at a statistically significant greater rate in patients who had undergone previous lumbar surgery, had greater pelvic incidence, and had poor restoration of lumbar lordosis and/or sagittal balance (that is, undercorrection). Patients with a greater number of comorbidities and preoperative coronal imbalance showed trends toward an increase in major failures, although these trends did not reach statistical significance. Age, sex, body mass index, smoking history, number of fusion segments, fusion grade, and several other radiographic values were not shown to be associated with an increased risk of major failure. Seventy percent of patients in the major failure group had anterior column support (anterior lumbar interbody fusion or transforaminal lumbar interbody fusion) while 80% of the nonfailure group had anterior column support. Conclusions The incidence of overall failure was 34.3%, and the incidence of clinically significant major failure of lumbopelvic fixation after long construct fusion for adult spinal deformity was 11.9%. Risk factors for major failures are a large pelvic incidence, revision surgery, and failure to restore lumbar lordosis and sagittal balance. Surgeons treating adult spinal deformity who use lumbopelvic fixation should pay special attention to restoring optimal sagittal alignment to prevent lumbopelvic fixation failure.

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