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Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs. METHODS: We performed a retrospective review of consecutive adul...

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Autores principales: Merrill, Robert K., Kim, Jun S., Leven, Dante M., Kim, Joung Heon, Cho, Samuel K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582710/
https://www.ncbi.nlm.nih.gov/pubmed/28894680
http://dx.doi.org/10.1177/2192568217699392
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author Merrill, Robert K.
Kim, Jun S.
Leven, Dante M.
Kim, Joung Heon
Cho, Samuel K.
author_facet Merrill, Robert K.
Kim, Jun S.
Leven, Dante M.
Kim, Joung Heon
Cho, Samuel K.
author_sort Merrill, Robert K.
collection PubMed
description STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs. METHODS: We performed a retrospective review of consecutive adult spinal deformity patients who underwent long fusion to the pelvis. Inclusion criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and minimum 1-year follow-up. Revision patients with indications other than L5-S1 pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed for rod integrity, and computed tomography scan (CT) was obtained whenever rod breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were statistically compared. RESULTS: There were 31 patients with 15 in the dual-rod group and 16 in the multi-rod group, with average ages of 68 ± 9 and 63 ± 12 years, respectively. No patients in the multi-rod group experienced rod fracture, whereas 6 in the dual-rod group fractured a rod (P = .007), with 4 occurring at the lumbosacral junction (P = .04). CT scan in the 4 lumbosacral rod fracture cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic nonunion at the L5-S1 junction. CONCLUSION: Patients with dual-rod constructs had a statistically greater incidence of lumbosacral pseudarthrosis with implant failure than those with multi-rod constructs. CT and surgical exploration showed hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests that mechanical instability, not biology, is the main reason for failure, and could be addressed with the use of multi-rods.
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spelling pubmed-55827102017-09-11 Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity Merrill, Robert K. Kim, Jun S. Leven, Dante M. Kim, Joung Heon Cho, Samuel K. Global Spine J Original Articles STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs. METHODS: We performed a retrospective review of consecutive adult spinal deformity patients who underwent long fusion to the pelvis. Inclusion criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and minimum 1-year follow-up. Revision patients with indications other than L5-S1 pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed for rod integrity, and computed tomography scan (CT) was obtained whenever rod breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were statistically compared. RESULTS: There were 31 patients with 15 in the dual-rod group and 16 in the multi-rod group, with average ages of 68 ± 9 and 63 ± 12 years, respectively. No patients in the multi-rod group experienced rod fracture, whereas 6 in the dual-rod group fractured a rod (P = .007), with 4 occurring at the lumbosacral junction (P = .04). CT scan in the 4 lumbosacral rod fracture cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic nonunion at the L5-S1 junction. CONCLUSION: Patients with dual-rod constructs had a statistically greater incidence of lumbosacral pseudarthrosis with implant failure than those with multi-rod constructs. CT and surgical exploration showed hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests that mechanical instability, not biology, is the main reason for failure, and could be addressed with the use of multi-rods. SAGE Publications 2017-04-11 2017-09 /pmc/articles/PMC5582710/ /pubmed/28894680 http://dx.doi.org/10.1177/2192568217699392 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Merrill, Robert K.
Kim, Jun S.
Leven, Dante M.
Kim, Joung Heon
Cho, Samuel K.
Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title_full Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title_fullStr Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title_full_unstemmed Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title_short Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
title_sort multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582710/
https://www.ncbi.nlm.nih.gov/pubmed/28894680
http://dx.doi.org/10.1177/2192568217699392
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