The “kickstand rod” technique for correction of coronal imbalance in patients with adult spinal deformity: initial case series

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OBJECTIVE

The objective of this study was to describe and evaluate a new surgical procedure for the correction of coronal imbalance (CI) in adult spinal deformity patients, called the “kickstand rod” technique.

METHODS

The authors analyzed the records of 24 consecutive patients with pediatric and adult spinal deformity and CI treated between July 2015 and October 2017 with a long-segment fusion and a kickstand rod. For the kickstand rod technique, an iliac screw was placed on the ipsilateral side of the trunk shift and connected proximally through a side-by-side domino link to the thoracolumbar junction; this rod was distracted to promote coronal plane balancing. Distraction occurred with the rod on the contralateral side locked in order to preserve sagittal correction. Radiographic and clinical analyses were conducted to evaluate the outcomes and possible complications of the kickstand rod technique.

RESULTS

The mean age of the patients was 55 years (range 14–73 years). Eighteen of the 24 patients were female. CI preoperatively was a mean of 63 mm, and the mean measurement at the final follow-up (mean duration 1.4 years) was 47 mm. There were no neurological, vascular, or implant-related complications in any of the patients. One patient developed wound dehiscence that was successfully treated without implant removal, and one developed proximal junctional kyphosis requiring extension of the construct proximally. One patient also returned to the operating room for excision of a spinous process. There were no complaints about screw prominence, kickstand construct failure, or significant worsening of CI after surgery.

CONCLUSIONS

The kickstand rod technique is safe and effective for the correction of CI in spinal deformity patients. This technique was found to provide marked coronal correction and additional strength to the overall construct without significant adverse consequences.

ABBREVIATIONS ASD = adult spinal deformity; CI = coronal imbalance; C7SVA = C7–sacrum alignment; LL = lumbar lordosis; PCO = posterior column osteotomy; S2AI = sacral-alar-iliac.
Article Information

Contributor Notes

Correspondence Meghan Cerpa: The Spine Hospital, NewYork-Presbyterian/Columbia University Medical Center, New York, NY. mc4338@cumc.columbia.edu.INCLUDE WHEN CITING Published online November 29, 2019; DOI: 10.3171/2019.9.SPINE19389.Disclosures Dr. Pham reports being a consultant for Medtronic. Dr. Sielatycki reports owning stock in Balanced Back. Dr. Lenke reports being a consultant for Medtronic (money donated to charity); receiving royalties from Medtronic and Quality Medical Publishing; receiving reimbursement for airfare and hotels from Broadwater, the Seattle Science Foundation, Stryker Spine, the Spinal Research Foundation, AOSpine, and the Scoliosis Research Society; receiving grant support from the Scoliosis Research Society (money to his institution), EOS Imaging (money to his institution), and the Setting Scoliosis Straight Foundation (money to his institution); being an expert witness for Fox Rothschild, LLC, in a patent-infringement case; receiving philanthropic research funding from the Evans family and the Fox Family Foundation; and receiving grant and fellowship support from AOSpine (money to his institution).
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