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

Merrill, Robert; Kim, Jun; Leven, Dante M.; Kim, Joung Heon; Cho, Samuel K.

doi:10.1177/2192568217699392

Cited by 91 publications

(60 citation statements)

References 34 publications

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“…[ 2 ] Multi-rod constructs have been shown to increase the rigidity and durability of posterior instrumentation, with longer time to failure and fewer total failures compared to two-rod constructs in the lumbar spine. [ 4 , 8 , 9 ] To date, quadruple-rod constructs have not been popularized for deformity correction in the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

C2 quad-screws facilitate 4-rod fixation across the cervico-thoracic junction

Cady-McCrea¹,

Galgano²

2021

Surgical Neurology International

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Background: Cervical spine deformity is a potentially devitalizing problem. Contemporary techniques for repair and reconstruction include fusion using rods of tapered diameter alone, or quadruple-rod constructs in which primary rods are joined to floating accessory rods by connectors. Here, we present how we utilized a quadruple-rod construct to perform five C2 to thoracic spine fusions. Methods: Our hospital electronic medical record revealed five patients who underwent the four rod C2-thoracic spine fixation. Patients ranged in age from 14-years-old to 78-years-old. The mean operative time was 715.8 min (range 549–987 min), and average estimated blood loss was 878 cc (range 40–1800 cc). Results: None of the five patients sustained any intraoperative complications, and none demonstrated progressive kyphotic deformity over the average follow-up interval of 8 months. Conclusion: We successfully treated five patients with degenerative or oncologic cervical pathology requiring fixation across the cervicothoracic junction utilizing a 4-rod C2-cervicothoracic fusion technique.

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Section: Discussionmentioning

confidence: 99%

C2 quad-screws facilitate 4-rod fixation across the cervico-thoracic junction

Cady-McCrea¹,

Galgano²

2021

Surgical Neurology International

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“…Insufficient stability at this level can result in pseudarthrosis and implant failure. [9][10][11][12] Fortunately, the pelvis has enough volume and cortical mass to accommodate several large-diameter screws. We discuss and illustrate the safe and effective placement of multiple S2AI and pelvic screws to achieve rigid fixation.…”

Section: Discussionmentioning

confidence: 99%

“…8 With a solid foundation established in the pelvis, various techniques may be employed to insert additional rods across the lumbosacral junction to reinforce the overall spinal construct [13][14][15][16] for both structural support as well as achieving additional lumbar lordosis. 17,18 It has been shown that the use of multirod constructs can prevent rod failure and pseudarthrosis, 12 likely by increasing mechanical stability and reducing L5-S1 motion. 15 Four-rod constructs have been shown to be stronger in a biomechanical and cadaveric model.…”

Section: Discussionmentioning

confidence: 99%

“…In spinal deformity surgery, especially complex revision cases, stability across the lumbosacral junction is critical and relies greatly on the quality of pelvic fixation. Insufficient stability at this level can result in pseudarthrosis and implant failure [ 9 - 12 ]. Fortunately, the pelvis has enough volume and cortical mass to accommodate several large-diameter screws.…”

Section: Discussionmentioning

confidence: 99%

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Dual S2 Alar-Iliac Screw Technique With a Multirod Construct Across the Lumbosacral Junction: Obtaining Adequate Stability at the Lumbosacral Junction in Spinal Deformity Surgery

et al. 2020

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To illustrate the safe placement of a 5-screw/5-rod construct across the spinopelvic junction in a complex revision case utilizing 4 S2 alar-iliac (S2AI) screws as well as an iliac screw for a kickstand rod. The S2AI screws are often used for lumbosacral fixation at the base of long spinal deformity constructs. In severe spinal deformities, additional pelvic fixation beyond the standard 2 screws may help achieve and maintain correction, and also increase the rigidity of the construct. With a thorough understanding of pelvic anatomy, multiple pelvic screws, such as bilateral dual S2AI screws, may be placed safely to achieve stability and accommodate additional rods to perform powerful correction techniques. We illustrate the safe use of multiple rods across the lumbosacral junction in this case, by using both a hook rod construct and domino connectors-ultimately though these additional rods rely on the integrity of the pelvic fixation to provide their support. We recommend at least 3 rods across the lumbosacral junction in any adult spinal deformity case requiring pelvic fixation, and would recommend considering more than 3 rods, especially across 3-column osteotomy sites. For long spinal constructs in patients with significant adult spinal deformity, we believe the use of multiple pelvic screws to a multirod construct is a safe and effective way to provide long-term correction and clinical success.

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“…Previous broken rod on the right side was replaced by multi-RC using cobalt chrome (CoCr) rod. Patients with conventional 2-rod constructs (2-RC) had a statistically greater incidence of lumbosacral pseudarthrosis than those with multi-rod constructs in adult spinal deformity surgery 19) . In addition, in another study, there were significant differences in the occurrence of rod breakage and revision surgery for pseudarthrosis at the 3-column osteotomy site (rod breakage, 2-RC : 11 vs. multi-RC : 2, p=0.002; and revision, 2-RC : 6 vs. multi-RC : 0, p=0.011) 9,16) .…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

Park

Hyun

Wui

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1). Methods : From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre-and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre-and postoperative scoliosis research society-22r (SRS-22r) score. Results : Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of-3.5±1.0. All patients underwent surgical correction via posterior approach. The pre-and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury. Conclusion : The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.

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

Cited by 91 publications

References 34 publications

C2 quad-screws facilitate 4-rod fixation across the cervico-thoracic junction

C2 quad-screws facilitate 4-rod fixation across the cervico-thoracic junction

Dual S2 Alar-Iliac Screw Technique With a Multirod Construct Across the Lumbosacral Junction: Obtaining Adequate Stability at the Lumbosacral Junction in Spinal Deformity Surgery

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

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