The “Kickstand Rod” Technique for Coronal Imbalance in Patients With Spinal Deformity: A Case Report With Review of Literature

Abstract

Coronal imbalance is a type of spinal deformity with deviation from midline in the coronal plane. It is challenging to correct even in the hands of experienced spine surgeons. Many conventional techniques lead to unsuccessful results or complications. However, the incorporation of "kickstand rod" (KR) instrumentation is now understood to provide a more supported coronal correction and improve spinal deformities. Sometimes it can be used to provide additional spinal support in instances where spinal fusion has already occurred. The KR is placed from a posterior approach along the lateral spine from lumbar spine to ilium and exerts distraction forces that counteract misaligned spinal segments. Our objective is to present a clinical case example with a brief review of literature. Herein, we present a case of a 62-year-old male with the development of significant coronal imbalance following his posterior lumbosacral instrumentation and fusion 11 years prior to presentation. KR supplementation to his hardware improved his functional outcome significantly. Further, we provide a literature review of the surgical characteristics, indications, and functional outcomes of KR instrumentation. A term search of "kickstand rod" was performed in PubMed, and relevant English language publications were included. The literature search yielded only six publications. A total of 45 patients across three studies were assessed. A mean postoperative coronal balance magnitude of 26.83 mm was calculated compared to the preoperative coronal magnitude of 64.16 mm. Results also showed only four cases of intraoperative or postoperative complications. Moreover, the presented case reported successful KR implementation without any intraoperative complications. KR instrumentation is a safe and effective technique for coronal imbalance correction. The results show favorable outcomes in terms of coronal adjustment and low complication rates. Nevertheless, we caution the fact that further studies are warranted with long-term follow-ups.

The kickstand rod technique for correction of coronal malalignment in patients with adult spinal deformity: a systematic review and pooled analysis of 97 cases

“…In biomechanical studies, accessory rods help maintain correction and limit the range of motion across the instrumented spinal segment [ 29 , 30 ]. The kickstand rod provides a theoretical additional advantage of correction of the scoliotic curve in patients with ASD, along with the less invasiveness of the procedure and additional biomechanical support in long posterior constructs [ 31 ] ( Fig. 9 ).…”

New Effective Intraoperative Techniques for the Prevention of Coronal Imbalance after Circumferential Minimally Invasive Correction Surgery for Adult Spinal Deformity

“…The KR technique used in this study was first described in a case report by Makhni et al in 2018 [22]. Other studies have also demonstrated its usefulness [25,[37][38][39]. However, the measures used in this study, such as RR and SD, have not been described in previous studies.…”

Placement of a Kickstand Rod in Adult Spinal Deformity Surgery: A Simple 8-Step Process With Intraoperative Images and Video

“…Vector forces are then applied to the opposite side of the coronal deviation, which depresses the ipsilateral pelvis and improves coronal correction. 12,13 Although multiple studies have demonstrated the efficacy of the KSR technique in restoring coronal alignment, 3,4,[14][15][16][17] an in-depth, step-by-step description of how to implement the technique is lacking. In addition, reports with intraoperative images and videos are sparse.…”