Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: A finite element study

Januszewski, Jacob; Beckman, Joshua; Harris, Jeffrey E.; Turner, Alexander W.; Yen, Chun Po; Uribe, Juan S.

doi:10.4103/sni.sni_44_17

Cited by 35 publications

(37 citation statements)

References 28 publications

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“…Most important, rates of pseudarthrosis and rod failure were lower when four rods were placed. This is especially important for patients requiring higher grade osteotomies, given the substantial biomechanical stress created across osteotomy sites [20, 48]. The authors acknowledge the complex relationship between rod fracture and pseudarthrosis.…”

Section: Resultsmentioning

confidence: 99%

Advances in Spinal Fusion Strategies in Adult Deformity Surgery

Steinberger

York

Virk

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background As the frequency of adult deformity surgery (ADS) continues to increase, our understanding of techniques that enhance fusion must continue to evolve because pseudarthrosis can be a serious and costly event. Purposes/Questions We sought to conduct a review of the literature investigating techniques that can enhance outcomes of ADS. Methods Two databases were searched for keywords such as “advances in spinal fusion,” “new technology in adult spinal deformity,” “interbody devices for adult spinal deformity,” “adult spinal deformity rods,” and “screw design in adult spinal deformity” to examine recent literature and trends in ADS. Results We identified 45 articles for our review. Topics studied include the use of multiple rods, interbody fusion, distal fixation techniques, and bone morphogenetic protein or iliac crest bone graft. Conclusions Many recent innovations in treatments to enhance fusion in ADS have been studied, some more controversial than others. Further research into the efficacy of these techniques may increase fusion rates in ADS.

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Section: Resultsmentioning

confidence: 99%

Advances in Spinal Fusion Strategies in Adult Deformity Surgery

Steinberger

York

Virk

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…Outcomes of a basic experiment reported that the combination of satellite rods reduced the stress on rods by 59% [ 20 ]. It was reported that usage of satellite rods in patients with Scheuermann kyphosis resulted in greater correction and maintenance of the correction [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures

et al. 2021

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Combination of retrospective and prospective study. Purpose: We aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment. Overview of Literature: The clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved. Methods: We analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period. Results: In the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively (p-value <0.05). There was no significant difference in the incidence of PJK in the local and pelvic groups, but there was a higher rate of DJK (41.7%) in the local group. In contrast, rod fractures were more common in the pelvic group (45.5%). Patients with DJK had higher ODI scores 2 years after surgery (52.0 in DJK patients vs. 34.8 in non-DJK patients; p-value <0.05). Conclusions: For patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.

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“…Основное преимущество заключается в распределении нагрузок между бóльшим числом стержней, что, соответственно, снижает индивидуальную нагрузку на каждый стержень в отдельности. Так, результаты биомеханических исследований, основанных на анализе конечных элементов на кадаверных моделях позвоночника, показали, что при проведении PSO четырехстержневая фиксация обеспечивает снижение нагрузки на основные стержни на 50% при сгибании, на 43% -при боковых наклонах и на 27% -при ротации по сравнению с двухстержневой фиксацией [42]. Результаты другого биомеханического исследования, проведенного J.A.…”

Section: Discussionunclassified

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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Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: A finite element study

Cited by 35 publications

References 28 publications

Advances in Spinal Fusion Strategies in Adult Deformity Surgery

Advances in Spinal Fusion Strategies in Adult Deformity Surgery

Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures

Еffectiveness of Four-Rod Fixation for Pedicle Subtraction Spinal Osteotomy

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