Operative neurosurgery (Hagerstown, Md.) · 2018
A Novel 4-Rod Technique Offers Potential to Reduce Rod Breakage and Pseudarthrosis in Pedicle Subtraction Osteotomies for Adult Spinal Deformity Correction.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Gupta Sachin, Eksi Murat Sakir, Ames Christopher P, Deviren Vedat, Durbin-Johnson Blythe, Smith Justin S, Gupta Munish C
Аннотация
BACKGROUND: Pedicle subtraction osteotomy (PSO) can be used to treat rigid sagittal plane deformities. Nonunions and rod breakages are known complications of PSO.
OBJECTIVE: To assess outcomes of 2 methods of posterior instrumentation for PSO, traditional 2 rods vs a novel 4-rod technique in which 2 additional rods span only the osteotomy level.
METHODS: This study was a retrospective, radiographic review of consecutive PSOs performed at 2 centers. The primary difference in technique between the centers was the use of 4 rods including 2 independent rods attached only to the vertebral levels immediately adjacent to the PSO (group 1, n = 29 patients) vs the traditional 2-rod technique (group 2, n = 20 patients).
RESULTS: Demographics and preoperative to postoperative radiographic measurements were similar between the study groups, including the PSO wedge resection angle (P = .56). The rod breakage rate was 25% with 2 rods and 0% with 4 rods (P = .008), and the pseudarthrosis rate with 2 rods was 25% and with 4 rods was 3.4% (P = .035). The patient with pseudarthrosis from group 1 had an infection and developed pseudarthrosis only after instrumentation removal. Rates of other complications did not differ significantly between the study groups.
CONCLUSION: This study provides a comparison between 2 techniques for rod placement across a PSO and suggests that the described novel 4-rod technique may help to reduce the rates of pseudarthrosis and rod failure. It will be important to confirm these findings in a prospectively designed study with multiple institutions in order to better control for potentially confounding factors.
OBJECTIVE: To assess outcomes of 2 methods of posterior instrumentation for PSO, traditional 2 rods vs a novel 4-rod technique in which 2 additional rods span only the osteotomy level.
METHODS: This study was a retrospective, radiographic review of consecutive PSOs performed at 2 centers. The primary difference in technique between the centers was the use of 4 rods including 2 independent rods attached only to the vertebral levels immediately adjacent to the PSO (group 1, n = 29 patients) vs the traditional 2-rod technique (group 2, n = 20 patients).
RESULTS: Demographics and preoperative to postoperative radiographic measurements were similar between the study groups, including the PSO wedge resection angle (P = .56). The rod breakage rate was 25% with 2 rods and 0% with 4 rods (P = .008), and the pseudarthrosis rate with 2 rods was 25% and with 4 rods was 3.4% (P = .035). The patient with pseudarthrosis from group 1 had an infection and developed pseudarthrosis only after instrumentation removal. Rates of other complications did not differ significantly between the study groups.
CONCLUSION: This study provides a comparison between 2 techniques for rod placement across a PSO and suggests that the described novel 4-rod technique may help to reduce the rates of pseudarthrosis and rod failure. It will be important to confirm these findings in a prospectively designed study with multiple institutions in order to better control for potentially confounding factors.