Outrigger rod technique for supplemental support of posterior spinal arthrodesis

Palumbo, Mark A.; Shah, Kalpit N.; Eberson, Craig P.; Hart, Robert A.; Daniels, Alan H.

doi:10.1016/j.spinee.2015.03.004

Cited by 42 publications

(22 citation statements)

References 29 publications

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“…10,13,21,30,38,44,45,55,61,80 Techniques utilizing bridging rods or novel rod constructs have decreased but not eliminated this risk. 10,38,44,45,55,61 The anterior column resection (ACR) technique was first described in 2011 as a means of increasing the lordosis that could be obtained by lateral interbody grafts, more similar in correction to an anteriorly placed graft than the conventional lateral grafts that had been used up until that point in time. 14,58,75 Parallel and mildly lordotic (5°-10°) lateral grafts have been used to treat scoliotic curvatures with reasonable results, but these corrections are typically much more impressive in the coronal plane than the sagittal plane, suggesting that lateral techniques may apply primarily to treatment of patients with minimal or no sagittal imbalance.…”

Section: Discussionmentioning

confidence: 99%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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OBJECTIVEPedicle subtraction osteotomy (PSO) provides extensive correction in patients with fixed sagittal plane imbalance but is associated with high estimated blood loss (EBL). Anterior column realignment (ACR) with lateral graft placement and sectioning of the anterior longitudinal ligament allows restoration of lumbar lordosis (LL). The authors compare peri- and postoperative measures in 2 groups of patients undergoing correction of a sagittal plane imbalance, either through PSO or the use of lateral lumbar fusion and ACR with hyperlordotic (20°–30°) interbody cages, with stabilization through standard posterior instrumentation in all cases.METHODSThe authors performed a retrospective chart review of cases involving a lumbar PSO or lateral lumbar interbody fusion and ACR (LLIF-ACR) between 2010 and 2015 at the authors’ institution. Patients who had a PSO in the setting of a preexisting fusion that spanned more than 4 levels were excluded. Demographic characteristics, spinopelvic parameters, EBL, operative time, and LOS were analyzed and compared between patients treated with PSO and those treated with LLIF-ACR.RESULTSThe PSO group included 14 patients and the LLIF-ACR group included 13 patients. The mean follow-up was 13 months in the LLIF-ACR group and 26 months in the PSO group. The mean EBL was significantly lower in the LLIF-ACR group, measuring approximately 50% of the mean EBL in the PSO group (1466 vs 2910 ml, p < 0.01). Total LL correction was equivalent between the 2 groups (35° in the PSO group, 31° in the LLIF-ACR group, p > 0.05), as was the preoperative PI-LL mismatch (33° in each group, p > 0.05) and the postoperative PI-LL mismatch (< 1° in each group, p = 0.05). The fusion rate as assessed by the need for reoperation due to pseudarthrosis was lower in the LLIF-ACR group but not significantly so (3 revisions in the PSO group due to pseudarthrosis vs 0 in the LLIF-ACR group, p > 0.5). The total operative time and LOS were not significantly different in the 2 groups.CONCLUSIONSThis is the first direct comparison of the LLIF-ACR technique with the PSO in adult spinal deformity correction. The study demonstrates that the LLIF-ACR provides equivalent deformity correction with significantly reduced blood loss in patients with a previously unfused spine compared with the PSO. This technique provides a powerful means to avoid PSO in selected patients who require spinal deformity correction.

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Section: Discussionmentioning

confidence: 99%

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Lévêque

Yanamadala

Buchlak

et al. 2017

Neurosurgical Focus

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“…The use of dual S2AI screws bilaterally, in addition to a kickstand rod, has helped maintain significant correction in the patient discussed here. 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.…”

Section: Discussionmentioning

confidence: 99%

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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“…The multi-rod construct increases the metal bulk, which could result in additional metal artifact with post-operative imaging [13]. The increased space occupation by the lateral and posterior multi-rod construct could also affect wound closure and osseous healing process [13,34], due to proportionally less space available for placement of graft material [34]. Furthermore, the subordinate rods are piggybacked off of the primary two longitudinal rods, as a consequence, the stress transfers distally or proximally and eventually the primary rod is prone to break above or below the satellite rod, although not occur in our research [30,34,35].…”

Section: Discussionmentioning

confidence: 99%

Total en bloc spondylectomy combined with the satellite rod technique for spinal tumors

Wei

Dong

et al. 2020

Preprint

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Background: Instrumentation failure (IF) is a common complication after total en bloc spondylectomy (TES) in spinal tumors. This study aims to evaluate the clinical outcomes of TES combined with the satellite rod technique for the treatment of primary and metastatic spinal tumors.Methods: The clinical data of 15 consecutively treated patients with spinal tumors who underwent TES combined with satellite rod technique by a single posterior approach from June 2015 to September 2018 were analyzed retrospectively. Radiographic parameters including the local kyphotic angle (LKA), anterior vertebral height (AVH), posterior vertebral height (PVH) and intervertebral titanium mesh cage height (ITMCH) were assessed preoperatively, postoperatively and at the final follow-up. The visual analog scale (VAS), Oswestry Disability Index (ODI) and American Spinal Injury Association (ASIA) scale were used to assess quality of life and neurological function. The operative duration, volume of blood loss, and complications were also recorded.Results: The mean operation time and volume of blood loss were 361.7 min and 2816.7 mL, respectively. During an average follow-up of 31.1 months, 2 patients died of tumor recurrence and multiple organ metastases, while recurrence was not found in any other patients. Solid fusion was achieved in all but one patient, and no implant-related complications occurred during the follow-up. The VAS, ODI and ASIA scores significantly improved from before to after surgery (P<0.05). The LKA, AVH and PVH significantly improved from before to immediately after surgery and to the final follow-up (P<0.05), and the postoperative and final follow-up values did not significantly differ (P>0.05).Conclusions: TES combined with the satellite rod technique can yield strong three-dimensional fixation and reduce the occurrence of rod breakage, thereby improving the long-term quality of life of patients with spinal tumors.

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Outrigger rod technique for supplemental support of posterior spinal arthrodesis

Cited by 42 publications

References 29 publications

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

Correction of severe spinopelvic mismatch: decreased blood loss with lateral hyperlordotic interbody grafts as compared with pedicle subtraction osteotomy

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

Total en bloc spondylectomy combined with the satellite rod technique for spinal tumors

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