Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
| Autor: | Samuel K. Cho, Joung Heon Kim, Dante M. Leven, Robert K. Merrill, Jun S. Kim |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
genetic structures hypertrophic nonunion 03 medical and health sciences multi-rod fusion 0302 clinical medicine Medicine Pelvic fixation Orthopedics and Sports Medicine Pelvis 030222 orthopedics business.industry rod fracture pseudarthrosis Retrospective cohort study Original Articles medicine.disease pelvic fixation Surgery lumbosacral junction Lower incidence Pseudarthrosis medicine.anatomical_structure Spinal deformity Neurology (clinical) sense organs business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | Global Spine Journal |
| ISSN: | 2192-5690 2192-5682 |
| Popis: | Study Design: Retrospective cohort study. Objective: To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs. Methods: We performed a retrospective review of consecutive adult spinal deformity patients who underwent long fusion to the pelvis. Inclusion criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and minimum 1-year follow-up. Revision patients with indications other than L5-S1 pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed for rod integrity, and computed tomography scan (CT) was obtained whenever rod breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were statistically compared. Results: There were 31 patients with 15 in the dual-rod group and 16 in the multi-rod group, with average ages of 68 ± 9 and 63 ± 12 years, respectively. No patients in the multi-rod group experienced rod fracture, whereas 6 in the dual-rod group fractured a rod ( P = .007), with 4 occurring at the lumbosacral junction ( P = .04). CT scan in the 4 lumbosacral rod fracture cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic nonunion at the L5-S1 junction. Conclusion: Patients with dual-rod constructs had a statistically greater incidence of lumbosacral pseudarthrosis with implant failure than those with multi-rod constructs. CT and surgical exploration showed hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests that mechanical instability, not biology, is the main reason for failure, and could be addressed with the use of multi-rods. |
| Databáze: | OpenAIRE |
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