scholarly journals Characteristics and Risk Factors of Rod Fracture Following Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis

Neurospine ◽  
2021 ◽  
Vol 18 (3) ◽  
pp. 447-454
Author(s):  
Sung Hyun Noh ◽  
Kyung Hyun Kim ◽  
Jeong Yoon Park ◽  
Sung Uk Kuh ◽  
Keun Su Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Weighted Mean Difference ◽  
Advanced Age ◽  
Smoking History ◽  
Cochrane Library ◽  
Sagittal Vertical Axis ◽  
Rod Fracture

Objective: The aim of study is to investigate the features and risk factors of rod fracture (RF) following adult spinal deformity (ASD) surgery.Methods: We searched the PubMed, Embase, Web of Science, and Cochrane Library databases to identify relevant studies. Patient’s data including age, sex, body mass index (BMI), previous spine surgery, pedicle subtraction osteotomy (PSO), interbody fusion, fusion to the pelvis, smoking history, preoperative sagittal vertical axis (SVA), preoperative pelvic tilt (PT), preoperative pelvic incidence minus lumbar lordosis, preoperative thoracic kyphosis (TK), and change in the SVA were documented. Comparable factors were evaluated using odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI).Results: Seven studies were included. The overall incidence of RF following ASD surgery was 12%. Advanced age (WMD, 2.8; 95% CI, 1.01–4.59; p < 0.002), higher BMI (WMD, 1.98; 95% CI, 0.65–3.31; p = 0.004), previous spine surgery (OR, 1.47; 95% CI, 1.05–2.04; p = 0.02), PSO (OR, 2.28; 95% CI, 1.62–3.19; p < 0.0001), a larger preoperative PT (WMD, 6.17; 95% CI, 3.55–8.97; p < 0.00001), and a larger preoperative TK (WMD, 5.19; 95% CI, 1.41–8.98; p = 0.007) were identified as risk factors for incidence of RF.Conclusion: The incidence of RF in patients following ASD surgery was 12%. Advanced age, higher BMI, previous spine surgery, and PSO were significantly associated with an increased occurrence of RF. A larger preoperative PT and TK were also identified as risk factors for occurrence of RF following ASD surgery.

Prospective, Multicenter Assessment of Risk Factors for Early Rod Fracture Following Surgery for Adult Spinal Deformity (ASD)

2013 ◽  
Vol 13 (9) ◽  
pp. S8
Author(s):  
David M. Ibrahimi ◽  
Justin S. Smith ◽  
Eric O. Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Rod Fracture

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

2018 ◽  
Vol 18 (9) ◽  
pp. 1612-1624 ◽  
Author(s):  
Thamrong Lertudomphonwanit ◽  
Michael P. Kelly ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Steven J. McAnany ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Health Related Quality ◽  
Related Quality ◽  
Spinal Deformity Surgery ◽  
Health Related ◽  
Rod Fracture

Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity

2014 ◽  
Vol 21 (6) ◽  
pp. 994-1003 ◽  
Author(s):  
Justin S. Smith ◽  
Ellen Shaffrey ◽  
Eric Klineberg ◽  
Christopher I. Shaffrey ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Full Length ◽  
Consecutive Series ◽  
Inclusion Criteria ◽  
The Mean ◽  
Spine Radiographs ◽  
Rod Fracture

Object Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD. Methods This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age > 18 years, ≥5 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle ≥20°, sagittal vertical axis (SVA) ≥5 cm, pelvic tilt (PT) ≥25°, and thoracic kyphosis ≥60°. Results Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 ± 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 ± 6.5; the mean number of levels fused was 12.0 ± 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3–27 months); patients without RF had a mean follow-up of 19 months (range 12–24 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1° vs 21.9°, p = 0.016; and pelvic incidence [PI]–lumbar lordosis [LL] mismatch 29.6° vs 12.0°, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p < 0.001; and PI-LL mismatch reduction by 26.3° vs 10.9°, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p > 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01–15.8). Conclusions Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up. With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.

Reduced occurrence of primary rod fracture after adult spinal deformity surgery with accessory supplemental rods: retrospective analysis of 114 patients with minimum 2-year follow-up

2021 ◽  
pp. 1-12
Author(s):  
Emily P. Rabinovich ◽  
Thomas J. Buell ◽  
Tony R. Wang ◽  
Christopher I. Shaffrey ◽  
Justin S. Smith
Keyword(s):  
Retrospective Analysis ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Vertical Axis ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Inclusion Criteria ◽  
Sagittal Vertical Axis ◽  
Rod Fracture

OBJECTIVE Rod fracture (RF) after adult spinal deformity (ASD) surgery is reported in approximately 6.8%–33% of patients and is associated with loss of deformity correction and higher reoperation rates. The authors’ objective was to determine the effect of accessory supplemental rod (ASR) placement on postoperative occurrence of primary RF after ASD surgery. METHODS This retrospective analysis examined patients who underwent ASD surgery between 2014 and 2017 by the senior authors. Inclusion criteria were age > 18 years, ≥ 5 instrumented levels including sacropelvic fixation, and diagnosis of ASD, which was defined as the presence of pelvic tilt ≥ 25°, sagittal vertical axis ≥ 5 cm, thoracic kyphosis ≥ 60°, coronal Cobb angle ≥ 20°, or pelvic incidence to lumbar lordosis mismatch ≥ 10°. The primary focus was patients with a minimum 2-year follow-up. RESULTS Of 148 patients who otherwise met the inclusion criteria, 114 (77.0%) achieved minimum 2-year follow-up and were included (68.4% were women, mean age 67.9 years, average body mass index 30.4 kg/m2). Sixty-two (54.4%) patients were treated with traditional dual-rod construct (DRC), and 52 (45.6%) were treated with ASR. Overall, the mean number of levels fused was 11.7, 79.8% of patients underwent Smith-Petersen osteotomy (SPO), 19.3% underwent pedicle subtraction osteotomy (PSO), and 66.7% underwent transforaminal lumbar interbody fusion (TLIF). Significantly more patients in the DRC cohort underwent SPO (88.7% of the DRC cohort vs 69.2% of the ASR cohort, p = 0.010) and TLIF (77.4% of the DRC cohort vs 53.8% of the ASR cohort, p = 0.0001). Patients treated with ASR had greater baseline sagittal malalignment (12.0 vs 8.6 cm, p = 0.014) than patients treated with DRC, and more patients in the ASR cohort underwent PSO (40.3% vs 1.6%, p < 0.0001). Among the 114 patients who completed follow-up, postoperative occurrence of RF was reported in 16 (14.0%) patients, with mean ± SD time to RF of 27.5 ± 11.8 months. There was significantly greater occurrence of RF among patients who underwent DRC compared with those who underwent ASR (21.0% vs 5.8%, p = 0.012) at comparable mean follow-up (38.4 vs 34.9 months, p = 0.072). Multivariate analysis demonstrated that ASR had a significant protective effect against RF (OR 0.231, 95% CI 0.051–0.770, p = 0.029). CONCLUSIONS This study demonstrated a statistically significant decrease in the occurrence of RF among ASD patients treated with ASR, despite greater baseline deformity and higher rate of PSO. These findings suggest that ASR placement may provide benefit to patients who undergo ASD surgery.

Multiple-rod constructs and use of bone morphogenetic protein–2 in relation to lower rod fracture rates in 141 patients with adult spinal deformity who underwent lumbar pedicle subtraction osteotomy

2021 ◽  
pp. 1-11
Author(s):  
Qiunan Lyu ◽  
Darryl Lau ◽  
Alexander F. Haddad ◽  
Vedat Deviren ◽  
Christopher P. Ames
Keyword(s):  
Bone Morphogenetic Protein ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Bone Morphogenetic Protein 2 ◽  
Sagittal Vertical Axis ◽  
Morphogenetic Protein ◽  
Rod Fracture ◽  
Lumbar Pedicle

OBJECTIVE The purpose of this study was to compare rod fracture (RF) rates among three types of rod constructs (RCs) following lumbar pedicle subtraction osteotomy (PSO) for adult spinal deformity (ASD). METHODS A retrospective review of consecutive patients with adult spinal deformity who were treated with lumbar PSO between 2007 and 2017 was performed. The minimum follow-up was 2 years. Three RCs were compared: standard (2 main rods), satellite (2 main rods with satellite rod), and nested (2 main rods and 2 short rods spanning osteotomy). Outcomes examined included RF rate, time to RF, pseudarthrosis, and reoperation. Multivariate analysis was used. RESULTS A total of 141 patients were included 55 with standard, 23 with satellite, and 63 with nested RCs. The mean age was 65.2 years and 34.8% of patients were male. Radiographic preoperative and postoperative results were as follows: sagittal vertical axis (11.0 vs 3.9 cm), lumbar lordosis (28.5° vs 57.1°), pelvic tilt (30.6° vs 21.0°), pelvic incidence (61.5° vs 60.0°), distance between central sacral vertical line and C7 plumb line (2.2 vs 1.5 cm), and scoliosis (18.9° vs 11.3°). The average time to RF was 12.4 months. Overall RF, bilateral RF, pseudarthrosis, and reoperation rates were 22.7%, 5.0%, 20.6%, and 17.7%, respectively. Standard RCs had a significantly higher RF (36.4% vs 13.0% vs 14.3%, p = 0.008), bilateral RF (35.0% vs 0.0% vs 0.0%, p = 0.021), pseudarthrosis (34.5% vs 8.7% vs 12.7%, p = 0.004), and reoperation (30.9% vs 4.3% vs 11.1%, p = 0.004) rates. Satellite RCs (OR 0.21, p = 0.015), nested RCs (OR 0.24, p = 0.003), and bone morphogenetic protein–2 (OR 0.28, p = 0.005) were independently associated with lower odds of RF. CONCLUSIONS Use of multiple rods in the satellite RC and nested RC groups was associated with lower rates of RF, pseudarthrosis, and reoperations following lumbar PSO. Bone morphogenetic protein–2 was associated with a reduction in RF rate as well.

scholarly journals Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients

2017 ◽  
Vol 8 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Han Jo Kim ◽  
Sravisht Iyer ◽  
Basel G. Diebo ◽  
Michael P. Kelly ◽  
Daniel Sciubba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Area Under The Curve ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Spinal Deformity Surgery

Study Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P < .01) and more likely to have osteoporosis (29% vs 15.1%, P = .037) and liver disease (6.5% vs 1.4%, P = .027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P < .01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P = .028). VTE patients had a longer hospital stay (10 vs 7 days, P < .05) and higher mortality rate (6.3% vs 0.7%, P < .01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE ( r2 = .11, area under the curve = 0.74, P < .05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.

scholarly journals Risk factors for revision surgery following primary adult spinal deformity surgery in patients 65 years and older

2016 ◽  
Vol 25 (4) ◽  
pp. 486-493 ◽  
Author(s):  
Varun Puvanesarajah ◽  
Francis H. Shen ◽  
Jourdan M. Cancienne ◽  
Wendy M. Novicoff ◽  
Amit Jain ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Elderly Patients ◽  
Spinal Deformity ◽  
Revision Surgery ◽  
Adult Spinal Deformity ◽  
Posterolateral Fusion ◽  
Smoking History ◽  
Revision Risk

OBJECTIVE Surgical correction of adult spinal deformity (ASD) is a complex undertaking with high revision rates. The elderly population is poorly studied with regard to revision surgery, yet senior citizens constitute a rapidly expanding surgical demographic. Previous studies aimed at elucidating appropriate risk factors for revision surgery have been limited by small cohort sizes. The purpose of this study was to assess factors that modify the risk of revision surgery in elderly patients with ASD. METHODS The PearlDiver database (2005–2012) was used to determine revision rates in elderly ASD patients treated with a primary thoracolumbar posterolateral fusion of 8 or more levels. Analyzed risk factors included demographics, comorbid conditions, and surgical factors. Significant univariate predictors were further analyzed with multivariate analysis. The causes of revision at each year of follow-up were determined. RESULTS A total of 2293 patients who had been treated with posterolateral fusion of 8 or more levels were identified. At the 1-year follow-up, 241 (10.5%) patients had been treated with revision surgery, while 424 (18.5%) had revision surgery within 5 years. On univariate analysis, obesity was found to be a significant predictor of revision surgery at 1 year, while bone morphogenetic protein (BMP) use was found to significantly decrease revision surgery at 4 and 5 years of followup. Diabetes mellitus, osteoporosis, and smoking history were all significant univariate predictors of increased revision risk at multiple years of follow-up. Multivariate analysis at 5 years of follow-up revealed that osteoporosis (OR 1.98, 95% CI 1.60–2.46, p < 0.0001) and BMP use (OR 0.70, 95% CI 0.56–0.88, p = 0.002) were significantly associated with an increased and decreased revision risk, respectively. Smoking history trended toward significance (OR 1.37, 95% CI 1.10–1.70, p = 0.005). Instrument failure was consistently the most commonly cited reason for revision. Five years following surgery, it was estimated that the cohort had 68.8% survivorship. CONCLUSIONS For elderly patients with ASD, osteoporosis increases the risk of revision surgery, while BMP use decreases the risk. Other comorbidities were not found to be significant predictors of long-term revision rates. It is expected that within 5 years following the index procedure, over 30% of patients will require revision surgery.

scholarly journals Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series

Scoliosis ◽  
2015 ◽  
Vol 10 (1) ◽  
Author(s):  
Cameron Barton ◽  
Andriy Noshchenko ◽  
Vikas Patel ◽  
Christopher Cain ◽  
Christopher Kleck ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Case Series ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Posterior Correction ◽  
Rod Fracture

Minimum 2-Year Analysis of S2-Alar-Iliac Screw Fixation for Adult Spinal Deformity

2021 ◽  
pp. 219256822098447
Author(s):  
Alex S. Ha ◽  
Daniel Y. Hong ◽  
Andrew J. Luzzi ◽  
Josephine R. Coury ◽  
Meghan Cerpa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Deformity ◽  
Screw Fixation ◽  
Adult Spinal Deformity ◽  
Function Score ◽  
Coronal Alignment ◽  
Pain Group ◽  
Sagittal Vertical Axis ◽  
Radiographic Findings

Study Design: Retrospective cohort. Objective: Determine the rate and risk factors for S2AI screw-related pain after adult spinal deformity surgery with a minimum 2-year follow-up. Methods: A consecutive 83 spinal deformity patients undergoing surgical treatment between August 2015 and December 2017 with minimum 2-year follow-up for S2AI screw complication and screw-related pain were included. Linear regression was performed on various risk factors and postoperative S2AI screw-related pain. Subset analysis of 53 patients was performed on preoperative and postoperative SRS and ODI scores, operative data, and radiographic data. Results: The overall proportion of S2AI screw-related pain was 9.6%. An S2AI screw complication was identified radiographically in 10.8% of patients; among these, 22.2% experienced S2AI screw-related pain. 3.4% of all patients underwent S2A1 screw removal. The SRS, ODI, sagittal vertical axis (SVA), and coronal alignment scores/measurements improved following treatment in all patients. However, the mean difference for the pre and postoperative SRS function score (1.2 ± 0.5 vs 0.9 ± 0.8) and SVA (4.0 ± 4.9 cm vs 2.1 ± 4.8 cm) were higher for the pain group. Conclusions: A minimum 2-year analysis of S2AI screw fixation in adult spinal deformity patients showed that 9.6% of patients experienced S2AI screw-related pain and 3.4% of patients had S2A1 screws removed. The size and the number of S2AI screws did not predict postoperative pain, nor were radiographic findings correlated with clinical outcomes. The patient outcome scores, coronal alignment, and SVA improved for all patients, but within the pain group there was an overall larger change in the SVA and SRS function score.

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