Analysis of instrumentation failures after three column osteotomies of the spine

Kavadi, Niranjan; Tallarico, Richard A.; Lavelle, William F.

doi:10.1186/s13013-017-0127-x

Cited by 20 publications

(15 citation statements)

References 26 publications

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“…This value is like that commonly found in similar study series, [9][10][11][12] in which there is an approximate variation of between 25 and 40%. The high frequency of material breakage in these surgeries suggests that the biomechanical demand on this surgery is high.…”

Section: Discussionsupporting

confidence: 90%

Evaluation of Rod Breakage After Three-Column Osteotomy

et al. 2020

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Objective: To identify the incidence and possible risk factors associated with rod breakage in patients who underwent vertebral column resection (VCR) or pedicle subtraction osteotomy (PSO) to treat complex deformities of the spine. Methods: Retrospective analysis of a series of 32 patients operated from 2014 to 2018 in a single center. The patients were analyzed for demographic (sex, age), biometric (BMI), radiographical (pre-and postoperative angular variations), and surgical (arthrodesed and osteotomized levels) characteristics. Descriptive analyses were performed for the numerical variables (mean, standard deviation, maximum, median, and minimum) and frequency analysis was performed for the categorical variables. Logistic regression analysis was performed for the dependent variable "rod breakage", using a stepwise technique to select the variables for the best model, assuming statistical significance of 0.05. Results: Of the 32 patients selected, rod breakage occurred in 34.4%. Mean age was 36.6 years (± 19.8), ranging from 10 to 74 years, and the mean BMI was 25.1 (±6.0). Most patients were subjected to VCR (75.0%), were males (56.2%) and did not smoke (90.6%). Logistic regression analysis showed that "arthrodesed levels" were was positively associated with rod breakage (OR 1.72; CI95%: 1.13-3.10; p<0.05). The other factors were not associated with breakage. Conclusion: Rod breakage is a frequent complication after three-column osteotomy, especially in long constructions. Level of evidence III; Retrospective Study.

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Section: Discussionsupporting

confidence: 90%

Evaluation of Rod Breakage After Three-Column Osteotomy

et al. 2020

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“…По данным литературы, частота переломов стержней при операциях с применением PSO значительно выше, чем при операциях с применением остеотомий задней колонны позвоночника, и достигает 37%. При этом в подавляющем большинстве случаев (до 87%) переломы стержней происходят на уровне PSO или на уровне смежных сегментов [21,23,25,43,45]. Эти клинические данные подтверждают, что зона остеотомии является наиболее подверженной переломам областью фиксации.…”

Section: Discussionunclassified

“…Стандартная хирургическая методика при применении трехколонных остеотомий основана на двухстержневой транспедикулярной стабилизации. По данным литературы, такая фиксация при выполнении PSO связана с большой частотой осложнений -до 37% (из них до 87% на уровне PSO), в первую очередь -переломов элементов металлоконструкции и последующим формированием псевдоартроза в зоне остеотомии [15,[19][20][21][22][23][24][25][26][27]. Разными авторами предпринимались попытки предотвратить развитие осложнений за счет применения стержней из более прочного металла и дополнительных стержней, проведения дополнительного межтелового спондилодеза и сведения к минимуму угла деформации стержней в зоне остеотомии [12,[28][29][30][31][32].…”

Section: Introductionunclassified

Еffectiveness of Four-Rod Fixation for Pedicle Subtraction Spinal Osteotomy

Пантелеев

Mironov

Bukhtin

et al. 2018

Traumatology and Orthopedics of Russia

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Introduction.Pedicle subtraction osteotomy (PSO) provides for significant segmental correction of the sagittalbalance of the spine. At the same time, the technique is associated with a high risk of complications, with rod fracture at the osteotomy site being the most common. The purposeof this study — to assess the effectiveness of four-rod fixation compared to literature data on standardtwo-rod fixation in patients undergoing PSO. Materials and Methods.The study is a retrospective analysis of 47 consecutive patients with rigid spinaldeformities, who underwent pedicle subtraction osteotomy at the lumbar level. The average age of the patients (33 females and 14 males) was 59.7 years. In all cases spinal fixation carried out using a four-rod construct with additional short rods at the osteotomy site. The minimal postoperative follow-up was 2 years. A detailed analysis of the radiographic data was carried out with calculation of the global sagittal balance and spinopelvic parameters. A detailed assessment of complications in the early and late postoperative periods was also performed. After an exhaustive review of literature, a comparative analysis was made of the four-rod fixation technique with current literature data on the frequency of complications (in particular, rod fractures in the osteotomy zone) after two-rod fixation. Results.In all cases the osteotomy was performed at one level, most often at L3 (49%). The average length offixation was 9.8 segments. The average angle of segmental correction was 27.1°. In most cases, it was possible to achieve adequate correction of spinopelvic parameters. Among complications, bone resorption around screws was most prevalent (23.4% of cases). Proximal junctional kyphosis occurred in 12.8% of cases, neurologic deficit — in 14.9% of cases, infectious complications — in 10.6% cases. Asymptomatic pseudarthrosis, confirmed by CT data, was observed in 12.8% of patients. Rod fracture at the PSO site and adjacent segments was not observed in any of the cases. Rod fractures of other localization were observed in 10.6% of patients. Conclusion. According to the literature, the frequency of rod fractures at the osteotomy site is the most frequentcomplication of PSO. The results of this study showed that four-rod fixation in PSO significantly reduces the incidence of pseudarthrosis and rod fracture rate in the long-term follow-up and provides greater control over the process of osteotomy closure.

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“…Динамика поясничного лордоза: 68,4° (32-130°) -до операции, 54,8° (31-94°) -после операции, 56,5° (27-107°) -в конце периода наблюдения (рис. [1][2][3][4]. Ротация апикального позвонка составила в среднем до операции 55,8° (17-138°), сразу после операции -33,2° (3,5-123°), в конце периода наблюдения -35,8° (2,5-92°).…”

Section: результатыunclassified

“…В хирургии деформаций позвоночника существует ряд специфических вертебрологических осложнений, в число которых входят те, которые непосредственно связаны с металлоимплантатом: переломы стержней и шурупов, спонтанный демонтаж конструкции, смещение ее элементов, повреждение опорных костных структур, выстояние металлоимплантата под кожу. Переломам стержней эндокорректора как самостоятельной проблеме посвящен целый ряд публикаций [1][2][3][4][5][6][7][8], однако при кажущейся многочисленности в них практически отсутствует информация о том, как влияет осложнение на конечный результат лечения с позиции качества жизни. Именно аспект качества жизни пациентов представляется нам приоритетным для оценки отдаленного результата, а не только лучевые данные потери коррекции деформации позвоночника в трех плоскостях.…”

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Does a fracture of the endocorrector rod affect the quality of life of a patient with spinal deformity?

2019

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Objective. To assess the effect of endocorrector rod fractures on the final result of treatment and the quality of life of patients operated on for spinal deformities of different etiology. Material and Methods. The study included 3833 patients older than 10 years who were operated on for spinal deformities of various etiologies and had not been subjected to spinal surgery before admission to the clinic. In the pre-and postoperative periods, spondylograms in frontal and lateral projections in the standing position were studied using the Cobb method, the apical vertebra rotation was determined in accordance with the method of Sullivan et al. Patients answered questions of the SRS-24 questionnaire in the immediate and long-term follow-up periods. Results. In total, fractures of metal implant rods were detected in 85 (2.2 %) patients. The average scoliotic deformity in these patients was 84.5° before surgery, 49.9° after surgery, and 53.7° at the end of the follow-up period (postoperative progression was 3.8°). Thoracic kyphosis was 61.5° before surgery, 44.3° after surgery, and 48.7° at the end of the follow-up period; lumbar lordosis-68.4°, 54.8°, and 56.5°; and apical vertebra rotation-55.8°, 33.2° and 35.8°, respectively. According to the questionnaire data, patients estimated their appearance after surgery and general appearance somewhat lower and pain as less intense. Indicators of activity and function of the spine after the rod remounting were slightly lower than after the primary surgery. Remounting did not significantly affect the indicator of "consent to surgical treatment under the same conditions"-80.6 and 80.0 %. Цель исследования. Оценка влияния переломов стержней эндокорректора на конечный результат лечения и качество жизни пациентов, оперированных по поводу деформаций позвоночника различной этиологии. Материал и методы. В исследование включены 3833 пациента от 11 до 50 лет, оперированные по поводу деформаций позвоночника различной этиологии, которые не подвергались операциям на позвоночнике до поступления в клинику. В до-и послеоперационном периодах исследовали спондилограммы в прямой и боковой проекциях в положении пациента стоя с использованием метода Cobb, ротацию апикального позвонка определяли по Sullivan et al. В ближайшем и отдаленном послеоперационном периодах пациенты отвечали на вопросы анкеты SRS-24. Результаты. В общей сложности переломы стержней металлоимплантатов были выявлены у 85 (2,2 %) больных. Средняя величина сколиотической деформации у этих пациентов до операции-84,5°, после операции-49,9°, в конце периода наблюдения-53,7°

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Analysis of instrumentation failures after three column osteotomies of the spine

Cited by 20 publications

References 26 publications

Evaluation of Rod Breakage After Three-Column Osteotomy

Evaluation of Rod Breakage After Three-Column Osteotomy

Еffectiveness of Four-Rod Fixation for Pedicle Subtraction Spinal Osteotomy

Does a fracture of the endocorrector rod affect the quality of life of a patient with spinal deformity?

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