Abstract:
BACKGROUND:Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling. OBJECTIVE:To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity. METHODS:A multicenter, retrospective review of RF in adult spinal deformity was performed. Inclusion criteria were spinal deformity, age older than 18 years, and more than 5 levels posterior instrumented fusion. Rod failures were divided into early (≤12 months) and late (>12 months). RESULTS:Of 442 patients, 6.8% had symptomatic RF. RF rates were 8.6% for titanium alloy, 7.4% for stainless steel, and 2.7% for cobalt chromium. RF incidence after pedicle subtraction osteotomy (PSO) was 15.8%. Among patients with a PSO and RF, 89% had RF at or adjacent to the PSO. Mean time to early RF (63%) was 6.4 months (range, 2-12 months). Mean time to late RF (37%) was 31.8 months (range, 14-73 months). The majority of RFs after PSO (71%) were early (mean, 10 months). Among RF cases, mean sagittal vertical axis improved from preoperative (163 mm) to postoperative (76.9 mm) measures (P<.001); however, 16 had postoperative malalignment (sagittal vertical axis>50 mm; mean, 109 mm). CONCLUSION:Symptomatic RF occurred in 6.8% of adult spinal deformity cases and in 15.8% of PSO patients. The rate of RF was lower with cobalt chromium than with titanium alloy or stainless steel. Early failure was most common after PSO and favored the PSO site, suggesting that RF may be caused by stress at the PSO site. Postoperative sagittal malalignment may increase the risk of RF.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Smith JS,Shaffrey CI,Ames CP,Demakakos J,Fu KM,Keshavarzi S,Li CM,Deviren V,Schwab FJ,Lafage V,Bess S,International Spine Study Group.doi
10.1227/NEU.0b013e3182672aabsubject
Has Abstractpub_date
2012-10-01 00:00:00pages
862-7issue
4eissn
0148-396Xissn
1524-4040pii
00006123-201210000-00022journal_volume
71pub_type
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