Broken rods in spinal deformity surgery: an analysis of clinical experience and a literature review

Backgrоund. Rod fractures are one of the specific complications of spinal deformity surgery. The number of publications on this topic is small, and the conclusions are often contradictory. Aim. The aim of this study is to analyze the current situation concerning the problem of fractures of the rods in spinal deformities of various etiologies in terms of frequency and risk factors for this complication. Materials and methods. The study included 3,833 patients who underwent operations between 1996 and 2018. The inclusion criteria of being over 10 years of age with no history of spinal surgery were applied. Results. Fractures of metal implant rods were detected in 85 patients out of a total of 3,833 (2.2%). There was a significant difference between the groups of idiopathic and congenital scoliosis patients. A rod fracture in 62 of the 85 patients was the reason for reintervention to restore integrity with a connector or a full replacement. An increase in BMI by one raised the chance of a fracture by 1.07 times (p = 0.019). Increasing the age by one year increased the possibility of a fracture by 1.03 times (p = 0.039). A statistically significant association of the ventral stage of surgical treatment (discectomy and interbody fusion with autologous bone) where no fracture was detected (p = 0.403) was revealed. Being over 15 years old a statistically significant predictor was in the group under 20 years of age (p = 0.048). For BMI, there was no statistically significant threshold for fracture probability in the group under 20 years of age. It was confirmed that a hybrid fixation system produced a significantly lower percentage of complications than a hook system. A systematic literature review of sources on this topic included international databases (Scopus, Medline, and Google Scholar) as well as investigating the publications contained in the reference list. Conclusions. Rod fractures during surgery for spinal deformities of various etiologies are one of the typical complications. Fracture frequency in large study groups is small. The risk of developing this complication rises with both increasing BMI and patient age, although there is no statistically significant threshold for BMI relative to the chances of fracture in the group up to 20 years of age. Modern reticular systems of attachment of the endocorrector to the vertebral structures can dramatically reduce the risk of rod fracture during the postoperative period.

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The Effect of Single and Triple Testicular Biopsy Using Biopty Gun on Spermatogenesis in Pubertal Rats

Animals ◽

10.3390/ani11061569 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1569

Author(s):

Tomislav Šušnjar ◽

Ivana Kuzmić Prusac ◽

Ivan Švagelj ◽

Anđela Jurišić ◽

Tomislav Šušnjar ◽

...

Keyword(s):

Sperm Count ◽

Semen Analysis ◽

Study Groups ◽

Testicular Biopsy ◽

Male Rats ◽

Lower Percentage ◽

Control Group ◽

Sprague Dawley ◽

Left Testis ◽

Significant Difference

Background: The aim of this study was to compare consequences in single and triple testicular biopsy by biopty gun in pubertal rats using histological and immunohistochemical analysis. Methods: Thirty-two Sprague-Dawley male rats were used as the experimental model. The rats were randomly divided into three study groups. The rats from the first group (n = 12) received a single-biopsy of upper pole of the left testis, while the rats from the second group (n = 10) received triple-biopsy of upper and lower poles and lateral surface of left testis. The third group (n = 10) was a control group. On the eightieth day after the biopsy in all rats bilateral orchiectomy and funiculectomy were performed to obtain testicular tissue and sperm for analysis. The consequences of the puncture were observed by pathohistology, immunohistochemistry and semen analysis. Results: The results of the study showed lower percentage of sperm count (14.5 mill/mL vs. 16 mill/mL, p = 0.130), sperm motility (24.6% vs. 32.7%, p > 0.05), abnormal sperm (30% vs. 27%, p > 0.05), atrophic tubules (21% vs. 6%, p < 0.001), volume (1.7 mL vs. 2.28 mL, p < 0.01) and apoptotic index (1.56 vs. 1.19, p = 0.650) in the testes with a triple-biopsy compared to the testes with a single-biopsy. Semen analysis showed a borderline significant difference between the group with triple-biopsy where sperm count was lower than it in the control group (14.5 mill/mL vs. 17.5 mill/mL, p = 0.05). A single-biopsy has little effect on the testis, especially on overall fertility. A triple-biopsy showed higher degree of the testicular damage but without a significant impact on overall fertility. Semen analysis showed that single- and triple-biopsies did not have a significant effect on sperm count, motility and morphology. Conclusion: Biopty gun procedure is a cheap, simple and reliable method for testicular biopsy in rats without a significant effect on sperm count, motility and morphology.

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How Lumbar Disc Geometrics Affect the Risk for Rod Fracture in Patients Undergoing Adult Spinal Deformity Surgery: An Initial Report

Global Spine Journal ◽

10.1055/s-0036-1582869 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1582869-s-0036-1582869

Author(s):

David Briski ◽

Joseph Zavatsky ◽

Brandon Cook

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Lumbar Disc ◽

Initial Report ◽

Spinal Deformity Surgery ◽

Rod Fracture

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Surgeon-directed transcranial motor evoked potential spinal cord monitoring in spinal deformity surgery

The Bone & Joint Journal ◽

10.1302/0301-620x.103b3.bjj-2020-1278.r1 ◽

2021 ◽

Vol 103-B (3) ◽

pp. 547-552

Author(s):

Ramanare Sibusiso Magampa ◽

Robert Dunn

Keyword(s):

Spinal Cord ◽

Spinal Deformity ◽

Early Identification ◽

Evoked Potential ◽

Motor Evoked Potential ◽

Congenital Scoliosis ◽

Spinal Cord Monitoring ◽

Cord Injury ◽

Spinal Deformity Surgery ◽

Transcranial Motor Evoked Potential

Aims Spinal deformity surgery carries the risk of neurological injury. Neurophysiological monitoring allows early identification of intraoperative cord injury which enables early intervention resulting in a better prognosis. Although multimodal monitoring is the ideal, resource constraints make surgeon-directed intraoperative transcranial motor evoked potential (TcMEP) monitoring a useful compromise. Our experience using surgeon-directed TcMEP is presented in terms of viability, safety, and efficacy. Methods We carried out a retrospective review of a single surgeon’s prospectively maintained database of cases in which TcMEP monitoring had been used between 2010 and 2017. The upper limbs were used as the control. A true alert was recorded when there was a 50% or more loss of amplitude from the lower limbs with maintained upper limb signals. Patients with true alerts were identified and their case history analyzed. Results Of the 299 cases reviewed, 279 (93.3%) had acceptable traces throughout and awoke with normal clinical neurological function. No patient with normal traces had a postoperative clinical neurological deficit. True alerts occurred in 20 cases (6.7%). The diagnoses of the alert group included nine cases of adolescent idiopathic scoliosis (AIS) (45%) and six of congenital scoliosis (30%). The incidence of deterioration based on diagnosis was 9/153 (6%) for AIS, 6/30 (20%) for congenital scoliosis, and 2/16 (12.5%) for spinal tuberculosis. Deterioration was much more common in congenital scoliosis than in AIS (p = 0.020). Overall, 65% of alerts occurred during rod instrumentation: 15% occurred during decompression of the internal apex in vertebral column resection surgery. Four alert cases (20%) awoke with clinically detectable neurological compromise. Conclusion Surgeon-directed TcMEP monitoring has a 100% negative predictive value and allows early identification of physiological cord distress, thereby enabling immediate intervention. In resource constrained environments, surgeon-directed TcMEP is a viable and effective method of intraoperative spinal cord monitoring. Level of evidence: III Cite this article: Bone Joint J 2021;103-B(3):547–552.

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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

The Spine Journal ◽

10.1016/j.spinee.2018.02.008 ◽

2018 ◽

Vol 18 (9) ◽

pp. 1612-1624 ◽

Cited By ~ 17

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

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Comparison of Effectiveness between Cobalt Chromium Rods versus Titanium Rods for Treatment of Patients with Spinal Deformity: A Systematic Review and Meta-Analysis

Advances in Orthopedics ◽

10.1155/2020/8475910 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10

Author(s):

Frank D. Shega ◽

HongQi Zhang ◽

Daudi R. Manini ◽

MingXing Tang ◽

ShaoHua Liu

Keyword(s):

Spinal Deformity ◽

Thoracic Kyphosis ◽

Meta Analysis ◽

Statistical Significance ◽

Proximal Junctional Kyphosis ◽

Cobalt Chromium ◽

Correction Rate ◽

Significant Difference ◽

Rod Fracture ◽

Junctional Kyphosis

Background. Biomechanical properties of rods determine their ability to correct spinal deformity and prevention of postoperative sagittal and coronal changes. The selection of a proper rod material is crucial due to their specific mechanical properties that influence the surgical outcome. The purpose of this study is to compare the effectiveness of cobalt chromium rods versus titanium rods for the treatment of spinal deformity by a systematic review and meta-analysis. Methods. PubMed, EMBASE, and the Cochrane library were searched for observational and biomechanical studies comparing cobalt chromium and titanium rods in terms of correction rate, thoracic kyphosis, lumbar lordosis, incidence of rod fracture, fatigue life of contoured rod, bending stiffness of rods, and occurrence of proximal junctional kyphosis. The demographic data and mean values of outcomes of interest were extracted from each group and compared by their mean difference as an overall outcome measure. The Review Manager software (RevMan 5.3) was utilized at a 95% significance level. Results. Eleven eligible studies with 641 participants for 7 observational studies and 35 samples for 4 biomechanical studies were identified. There were no significant differences between cobalt chromium and titanium rods in the correction rate of spinal deformity. Postoperative thoracic kyphosis was well restored in the cobalt chromium group with statistical significance (p value = 0.009). The incidence of rod fracture was high in titanium rods compared to cobalt chromium rods with significant difference (p value = 0.0001). Proximal junctional kyphosis occurs more in the cobalt chromium group with a significant difference (p value = 0.0009). No statistical significance between two materials in terms of lumbar lordosis, fatigue of life, and bending stiffness of rods. Conclusion. The cobalt chromium rod is better than titanium rod for effective correction of spinal deformity and postoperative stability of the spine. However, the use of cobalt chromium rods is associated with increased risk of proximal junctional kyphosis.

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Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

Global Spine Journal ◽

10.1177/2192568220944170 ◽

2020 ◽

pp. 219256822094417

Author(s):

Cesar D. Lopez ◽

Venkat Boddapati ◽

Nathan J. Lee ◽

Marc D. Dyrszka ◽

Zeeshan M. Sardar ◽

...

Keyword(s):

Systematic Review ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Three Dimensional ◽

Deformity Correction ◽

Screw Placement ◽

Spinal Deformities ◽

Three Dimensional Printing ◽

Significant Difference ◽

Dimensional Printing

Study Design: Systematic review. Objectives: This current systematic review seeks to identify current applications and surgical outcomes for 3-dimensional printing (3DP) in the treatment of adult spinal deformity. Methods: A comprehensive search of publications was conducted through literature databases using relevant keywords. Inclusion criteria consisted of original studies, studies with patients with adult spinal deformities, and studies focusing on the feasibility and/or utility of 3DP technologies in the planning or treatment of scoliosis and other spinal deformities. Exclusion criteria included studies with patients without adult spinal deformity, animal subjects, pediatric patients, reviews, and editorials. Results: Studies evaluating the effect of 3DP drill guide templates found higher screw placement accuracy in the 3DP cohort (96.9%), compared with non-3DP cohorts (81.5%, P < .001). Operative duration was significant decreased in 3DP cases (378 patients, 258 minutes) relative to non-3DP cases (301 patients,272 minutes, P < .05). The average deformity correction rate was 72.5% in 3DP cases (245 patients). There was no significant difference in perioperative blood loss between 3DP (924.6 mL, 252 patients) and non-3DP cases (935.6 mL, 177 patients, P = .058). Conclusions: Three-dimensional printing is currently used for presurgical planning, patient and trainee communication and education, pre- and intraoperative guides, and screw drill guides in the treatment of scoliosis and other adult spinal deformities. In adult spinal deformity, the usage of 3DP guides is associated with increased screw accuracy and favorable deformity correction outcomes; however, average costs and production lead time are highly variable between studies.

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