Anouar Bourghli, Louis Boissière, David Kieser, Daniel Larrieu, Javier Pizones, Ahmet Alanay, Ferran Pellise, Franck Kleinstück, Ibrahim Obeid, on behalf of the European Spine Study Group
Neurospine 2021;18(4):816-823. Published online October 21, 2021
Objective To compare the radiological and functional outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either 2-rod or multiple-rod construct is applied.
Methods Sixty-seven patients met the inclusion criteria, and were categorized into 3 groups: 2 rods (2R), multiple rods around the PSO (MRP), multiple rods around the PSO and lumbosacral junction (MRL). Demographic data, operative parameters, spinopelvic parameters, functional outcomes, and complications were collected.
Results Health-related quality of life scores showed a better outcome at 6 months and last follow-up visits in the MRP and MRL groups which were noted on different domains of Scoliosis Research Society-22 questionnaire, 36-item Short Form Health Surve, and Oswestry Disability Index scores (p < 0.05). The 3 groups showed similar rates of rod-related complications with no significant difference (p = 0.95). And inside each group, distribution of complications between pseudarthrosis with revision and rod fracture without revision was also similar (p = 0.99).
Conclusion The use of multiple rods across the PSO did not show a better outcome when compared to single rods in terms of incidence and types of mechanical complications. However, better postoperative coronal alignment and health-related quality of life scores in the multiple rods group could be seen demonstrating an improved functional outcome.
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Pedikel-Subtraktions-Osteotomie: Zwei- versus Mehr-Stab-Fixierung
Objective The objective of this study was to compare the biomechanical differences of different rod configurations following anterior column realignment (ACR) and pedicle subtraction osteotomy (PSO) for an optimal correction technique and rod configuration that would minimize the risk of rod failure.
Methods A validated spinopelvic (L1-pelvis) finite element model was used to simulate ACR at the L3–4 level. The ACR procedure was followed by dual-rod fixation, and for 4-rod constructs, either medial/lateral accessory rods (connected to primary rods) or satellite rods (directly connected to ACR level screws). The range of motion (ROM), maximum von Mises stress on the rods, and factor of safety (FOS) were calculated for the ACR models and compared to the existing literature of different PSO rod configurations.
Results All of the 4-rod ACR constructs showed a reduction in ROM and maximum von Mises stress compared to the dual-rod ACR construct. Additionally, all of the 4-rod ACR constructs showed greater percentage reduction in ROM and maximum von Mises stress compared to the PSO 4-rod configurations. The ACR satellite rod construct had the maximum stress reduction i.e., 47.3% compared to dual-rod construct and showed the highest FOS (4.76). These findings are consistent with existing literature that supports the use of satellite rods to reduce the occurrence of rod fracture.
Conclusion Our findings suggest that the ACR satellite rod construct may be the most beneficial in reducing the risk of rod failure compared to all other PSO and ACR constructs.
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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.
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