Four rod instrumentation in long posterior spinal constructs

Four rod instrumentation in long posterior spinal constructs in order to prevent rod failure in high-risk patients after adult deformity surgery

March 2017

The spine journal: official journal of the North American Spine Society 17(3):S5
DOI:10.1016/j.spinee.2016.12.014

Authors:
Lambros Giuseppe Morassi
Masood Shafafy
Nasir Quraishi
Arion Kapinas

Four rod instrumentation in long posterior spinal constructs in order to prevent rod failure in high-risk patients after adult deformity surgery.

Four rod instrumentation in long posterior spinal constructs in order to prevent rod failure in high-risk patients after adult

deformity surgery

Morassi Giuseppe Lambros, Arion Kapinas, Nasir Quraishi,

Masood Shafafy; The Centre for Spinal Studies and Surgery, Nottingham UniversityHospitals,Queen’sMedicalCentre,DerbyRd,Nottingham

NG7 2UH

BACKGROUND CONTEXT: Instrumentation failure after complex spinal deformity correction procedures is a well-known complication.

The most common mode of instrumentation failure in long segment spinal fusion surgery is rod breakage. This complication consequently

will lead to loss of cor- rection, local pain and the need for revision surgery. The reinforcement of the usually 2 rod technique with additional

two rods creating a four rod con- struct could reduce the risk of rod breakage.

PURPOSE: The aim of this study was to evaluate the intermediate results of utilizing a four-rod construct at the high risk area of

instrumentation in patients undergoing posterior corrective surgery for adult spinal deformity. STUDY DESIGN/SETTING: A prospective

observational study was con- ducted between 1/2012–4/2015 in our institute.

PATIENT SAMPLE: 15 patients (12F, 3M) with average age of 56.6 (range 22–75) at high risk of instrumentation/rod breakage underwent

correction of adult deformity with long instrumentation to the pelvis received addi- tional 2 rods.

OUTCOME MEASURES: The primary end point for the study was ra- diological evidence of instrumentation/rod breakage. Patient based

primary (ODI) and secondary (VAS) outcome scores were also collected. METHODS: Patients were prospectively followed up and

evaluated clin- ically and radiographically at regular intervals. The average length of follow up was 28 months (range 18–39).

RESULTS: At the latest follow up, there was no radiological evidence of instrumentation failure. There was also improvement in disability

and pain mean ODI preop. 76%/mean ODI postop at latest FU 48% mean VAS preop. 8,6/mean ODI postop. at latest FU 6,7.

CONCLUSIONS: In the intermediate term four-rod instrumentation tech- nique seems to add additional protection against instrumentation

failure in high risk patients.

CONFLICTS OF INTEREST: None.