Strategies for prevention of rod fracture in adult spinal deformity: cobalt chrome rod, accessory rod technique, and lateral lumbar interbody fusion

Ki Young Lee MD, PhD, Jung-Hee Lee MD, PhD, Kyung-Chung Kang MD, PhD, Sang-Kyu Im MD, Hae Seong Lim MD, and Sun Whan Choi MD
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  • Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea
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OBJECTIVE

Restoring the proper sagittal alignment in adult spinal deformity (ASD) can improve radiological and clinical outcomes, but pseudarthrosis including rod fracture (RF) is a common problematic complication. The purpose of this study was to analyze the methods for reducing the incidence of RF in deformity correction of ASD.

METHODS

The authors retrospectively selected 178 consecutive patients (mean age 70.8 years) with lumbar degenerative kyphosis (LDK) who underwent deformity correction with a minimum 2-year follow-up. Patients were classified into the non-RF group (n = 131) and the RF group (n = 47). For predicting the crucial factors of RF, patient factors, radiographic parameters, and surgical factors were analyzed.

RESULTS

The overall incidence of RF was 26% (47/178 cases), occurring in 42% (42/100 cases) of pedicle subtraction osteotomy (PSO), 7% (5/67 cases) of lateral lumbar interbody fusion (LLIF) with posterior column osteotomy, 18% (23/129 cases) of cobalt chrome rods, 49% (24/49 cases) of titanium alloy rods, 6% (2/36 cases) placed with the accessory rod technique, and 32% (45/142 cases) placed with the 2-rod technique. There were no significant differences in the incidence of RF regarding patient factors between two groups. While both groups showed severe sagittal imbalance before operation, lumbar lordosis (LL) was more kyphotic and pelvic incidence (PI) minus LL (PI-LL) mismatch was greater in the RF group (p < 0.05). Postoperatively, while LL and PI-LL did not show significant differences between the two groups, LL and sagittal vertical axis correction were greater in the RF group (p < 0.05). Nonetheless, at the last follow-up, the two groups did not show significant differences in radiographic parameters except thoracolumbar junctional angles. As for surgical factors, use of the cobalt chrome rod and the accessory rod technique was significantly greater in the non-RF group (p < 0.05). As for the correction method, PSO was associated with more RFs than the other correction methods, including LLIF (p < 0.05). By logistic regression analysis, PSO, preoperative PI-LL mismatch, and the accessory rod technique were crucial factors for RF.

CONCLUSIONS

Greater preoperative sagittal spinopelvic malalignment including preoperative PI-LL mismatch was the crucial risk factor for RF in LDK patients 65 years or older. For restoring and maintaining sagittal alignment, use of the cobalt chrome rod, accessory rod technique, or LLIF was shown to be effective for reducing RF in ASD surgery.

ABBREVIATIONS ALIF = anterior lumbar interbody fusion; ASD = adult spinal deformity; LDK = lumbar degenerative kyphosis; LL = lumbar lordosis; LLIF = lateral lumbar interbody fusion; LSJ = lumbosacral junction; ODI = Oswestry Disability Index; PCO = posterior column osteotomy; PI = pelvic incidence; PI-LL = PI minus LL; PJK = proximal junctional kyphosis; PLIF = posterior lumbar interbody fusion; PSO = pedicle subtraction osteotomy; PT = pelvic tilt; RF = rod fracture; rhBMP-2 = recombinant human bone morphogenetic protein–2; SS = sacral slope; SVA = sagittal vertical axis; TK = thoracic kyphosis; TLJ = thoracolumbar junction; VAS = visual analog scale.

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Contributor Notes

Correspondence Jung-Hee Lee: Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea. ljhspine@gmail.com.

INCLUDE WHEN CITING Published online February 19, 2021; DOI: 10.3171/2020.8.SPINE201037.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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