Revision strategies for failed adult spinal deformity surgery

Martini, Carlotta; Langella, Francesco; Mazzucchelli, Luca; Lamartina, Claudio

doi:10.1007/s00586-019-06283-9

Cited by 7 publications

(3 citation statements)

References 22 publications

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“…The Benefit of Addressing Malalignment in Revision • Passias et al "kickstand" rod. 34 The authors emphasis on restoring sagittal alignment is congruent with the clinical message of our findings.…”

Section: Deformitysupporting

confidence: 87%

“…For patients without loss of correction and malalignment, authors performed proximal extension of the fusion with minimal stiffness and biomechanical load at the UIV while reducing LL at the inferior portion of the construct. In patients with sagittal and/or coronal malalignment, authors recommended correcting through usage of a “tie” rod or “kickstand” rod 34 . The authors emphasis on restoring sagittal alignment is congruent with the clinical message of our findings.…”

Section: Discussionsupporting

confidence: 58%

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The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery

Passias

Krol

Williamson

et al. 2022

Spine

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Study Design. Retrospective cohort study. Objective. Understand the benefit of addressing malalignment in revision surgery for proximal junctional kyphosis (PJK). Summary of Background Data. PJK is a common cause of revision surgery for adult spinal deformity patients. During a revision, surgeons may elect to perform a proximal extension of the fusion, or also correct the source of the lumbopelvic mismatch. Materials and Methods. Recurrent PJK following revision surgery was the primary outcome. Revision surgical strategy was the primary predictor (proximal extension of fusion alone compared with combined sagittal correction and proximal extension). Multivariable logistic regression determined rates of recurrent PJK between the two surgical groups with lumbopelvic surgical correction assessed through improving ideal alignment in one or more alignment criteria [Global Alignment and Proportionality (GAP), Roussouly-type, and Sagittal Age-Adjusted Score (SAAS)]. Results. A total of 151 patients underwent revision surgery for PJK. PJK occurred at a rate of 43.0%, and PJF at 12.6%. Patients proportioned in GAP postrevision had lower rates of recurrent PJK [23% vs. 42%; odds ratio (OR): 0.3, 95% confidence interval (CI): 0.1–0.8, P=0.024]. Following adjusted analysis, patients who were ideally aligned in one of three criteria (Matching in SAAS and/or Roussouly matched and/or achieved GAP proportionality) had lower rates of recurrent PJK (36% vs. 53%; OR: 0.4, 95% CI: 0.1–0.9, P=0.035) and recurrent PJF (OR: 0.1, 95% CI: 0.02–0.7, P=0.015). Patients ideally aligned in two of three criteria avoid any development of PJF (0% vs. 16%, P<0.001). Conclusions. Following revision surgery for PJK, patients with persistent poor sagittal alignment showed increased rates of recurrent PJK compared with patients who had abnormal lumbopelvic alignment corrected during the revision. These findings suggest addressing the root cause of surgical failure in addition to proximal extension of the fusion may be beneficial.

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Section: Deformitysupporting

confidence: 87%

Section: Discussionsupporting

confidence: 58%

The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery

Passias

Krol

Williamson

et al. 2022

Spine

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“…This condition often requires revision surgery with intra-and peri-operative complication risks of 18% and 39%, respectively [6]. Proximal junctional failure and rod fracture are cited by Yasuda et al [7] as the main causes of revision surgery following a mechanical failure problem, although the risk factors for this event should not be looked for in mechanical problems alone.…”

Section: Introductionmentioning

confidence: 99%

What Are the Risk Factors for Mechanical Failure in Spinal Arthrodesis? An Observational Study

Peccerillo,

Culcasi,

Ruisi

et al. 2024

Surgical Techniques Development

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Background: The aim of this study was to identify the incidence of early mechanical failure in the first post-surgical year in patients who had undergone spinal surgery and to assess the related risk factors. Methods: A retrospective observational study was conducted examining all patients who consecutively underwent arthrodesis surgery. The incidence of postoperative mechanical failure during the first year was calculated as the primary outcome. Results: A total of 237 patients were identified for statistical analysis. The median age of the group of patients was 47 years (IQR of 44), and 66.6% were female. The incidence of mechanical failure in the first postoperative year was 5.1% overall, with 12 events, and the median time between surgery and the need for revision surgery was 5 months (IQR = 7.75). ASA score (OR = 2.39; p = 0.134), duration of the surgical procedure (OR = 1.27; p = 0.118), and inability to walk at discharge (OR = 7.86; p = 0.007) were independent risk factors associated with the mechanical failure. Conclusions: A higher ASA score and longer duration of surgery were risk factors for mechanical failure in the first year in patients who had undergone spinal surgery and must be carefully considered when planning spinal surgery. Early recovery of ambulation must be encouraged to prevent mechanical failure.

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Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adult spine deformity

et al. 2022

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Purpose To assess clinical and safety outcomes associated with different rod materials and diameters in adult spinal deformity (ASD) surgery. Methods A systematic literature review and meta-analysis evaluated ASD surgery using pedicle screw fixation systems with rods of different materials and sizes. Postoperative outcomes (i.e., Cobb, sagittal vertical axis, and pelvic tilt angle) and complications (i.e., pseudarthrosis and rod breakage) were assessed. Random effects models (REMs) pooled data for outcomes reported in ≥ 2 studies. Results Among 50 studies evaluating ASD surgery using pedicle screw fixation systems, 17 described rod material/diameter. Postoperative outcomes did not statistically differ between cobalt–chromium (CoCr) vs. titanium (Ti) rods (n = 2 studies; mean [95% confidence interval (CI)] sagittal vertical axis angle: CoCr 37.00° [18.58°–55.42°] and Ti 32.58° [24.62°–40.54°]; mean [95% CI] pelvic tilt angle: CoCr 26.20° [22.87°–29.53°] and Ti 20.15° [18.0°–22.31°]). The pooled proportion (95% CI) of pseudarthrosis was 15% (7–22%) for CoCr and 12% (− 8–32%) for stainless steel (SS) (n = 2 studies each; Chi2 = 0.07, p = 0.79). The pooled proportion (95% CI) of broken rods was 12% (1–22%) for Ti (n = 3 studies) and 10% (2–19) for CoCr (n = 1 study). Among 6.0–6.35 mm rods, the pooled (95% CI) postoperative Cobb angle (n = 2) was 12.01° (9.75°–14.28°), sagittal vertical axis angle (n = 4) was 35.32° (30.02°–40.62°), and pelvic tilt angle was 21.11° (18.35°–23.86°). Conclusions For ASD patients undergoing posterior fixation and fusion, there are no statistically significant differences in postoperative outcomes or complications among rods of varying materials and diameters. Benchmark postsurgical outcomes and complication rates by rod material and diameter are provided. Level of Evidence III

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Revision strategies for failed adult spinal deformity surgery

Cited by 7 publications

References 22 publications

The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery

The Benefit of Addressing Malalignment in Revision Surgery for Proximal Junctional Kyphosis Following ASD Surgery

What Are the Risk Factors for Mechanical Failure in Spinal Arthrodesis? An Observational Study

Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adult spine deformity

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