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Shen Y, Sardar ZM, Greisberg G, Katiyar P, Malka M, Hassan F, Reyes J, Zuckerman SL, Marciano G, Lombardi JM, Lehman RA, Lenke LG. Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery: A Comparative Analysis. Spine (Phila Pa 1976) 2024; 49:443-455. [PMID: 38073177 DOI: 10.1097/brs.0000000000004892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/23/2023] [Indexed: 03/13/2024]
Abstract
STUDY DESIGN Asymptomatic cohort: prospective, cross-sectional, multicenter. Symptomatic: retrospective, multisurgeon, single-center. OBJECTIVE To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes. SUMMARY OF BACKGROUND DATA ASD leads to decreased quality of life. Studies have shown that coronal malignment (CM) is associated with worse surgical outcomes. MATERIALS AND METHODS A total of 468 adult participants were prospectively enrolled in the asymptomatic cohort. Totally, 172 symptomatic ASD patients with 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. Three cranial plumb line parameters: the positions of the plumb lines from the midpoint between the medial orbital rims (ORB-L5), the odontoid (OD-L5), and the C7 centroid (C7-L5) relative to the L5 pedicle, were measured. Each subject had plumb line medial (M), touching (T), or lateral (L) to either pedicle. The association between each group of patients and radiographic parameters, intraoperative variables, patient-reported outcomes, and clinical outcomes were analyzed. RESULTS In the asymptomatic cohort, OD-L5 was medial to or touching the L5 pedicle in 98.3% of volunteers. In the symptomatic patients, preoperative OD-L5-L exhibited higher mean age (56.2±14.0), odontoid-coronal vertical axis (OD-CVA) (5.5±3.3 cm), Oswestry disability index (ODI) score (40.6±18.4), pelvic fixation rate (56/62, 90.3%), OR time (528.4±144.6 min), median estimated blood loss (1300 ml), and durotomy rate (24/62, 38.7%). A similar pattern of higher CVA, preoperative ODI, intraoperative pelvic fixation rate, OR time, estimated blood loss, and durotomy rate was observed in ORB-L5-L and C7-L5-L patients. Final follow-up postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis (13.0%) and pseudarthrosis (17.4%). CONCLUSION Preoperative OD-L5, ORB-L5, and C7-L5 lateral to pedicles were associated with worse preoperative ODI and higher intraoperative complexity. Postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis and pseudarthrosis. Postoperative CM, approximated by the cranial plumb line lateral to the L5 pedicles, was associated with sagittal plane complications.
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Affiliation(s)
- Yong Shen
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Gabriella Greisberg
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Fthimnir Hassan
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Justin Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Gerard Marciano
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Ronald A Lehman
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY
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Younus I, Chanbour H, Ali MA, Zuckerman SL. Placement of a Kickstand Rod in Adult Spinal Deformity Surgery: A Simple 8-Step Process With Intraoperative Images and Video. Oper Neurosurg (Hagerstown) 2024; 26:381-388. [PMID: 38032221 DOI: 10.1227/ons.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In adult spinal deformity (ASD) surgery, operative correction of coronal malalignment remains a challenging surgical task. Given the proven effectiveness and longevity of the kickstand rod (KSR) technique and its powerful ability to correct coronal malalignment, this technique is an important tool to have available. Therefore, we sought to provide a simple 8-step description of the KSR technique using intraoperative images and video in a patient undergoing combined sagittal and coronal malalignment correction. METHODS A 68-year-old female with a previous history of T11-S1 posterior spinal fusion presented with mid thoracic back pain, leg paresthesias, and a right-leaning posture. The patient underwent a T4-pelvis extension of fusion, T8-11 posterior column osteotomies, and placement of a right-sided KSR to address her coronal malalignment. RESULTS The KSR technique is summarized in the following steps: (1) place kickstand screw, (2) place contralateral main rod and tighten all set plugs, (3) place ipsilateral main rod and keep rod long distally, (4) place a domino in the lower/mid thoracic area, (5) place the KSR and leave the rod long proximally, (6) tighten the ipsilateral main rod above the domino, (7) loosen the ipsilateral main rod below the domino, and (8) place a rod gripper below the domino and distract. Postoperatively, the coronal vertical axis improved from 4.8 to 0.6 cm, and the sagittal vertical axis improved from 9.5 to 3.9 cm. CONCLUSION The current case report provides a simple 8-step description of the KSR technique to improve coronal malalignment accompanied by intraoperative images and video.
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Affiliation(s)
- Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Mir Amaan Ali
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA
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Rod fractures after multi-rod constructs in adult spinal deformity patients fused to the sacrum/pelvis: where do they occur and why? Spine Deform 2023; 11:471-479. [PMID: 36396901 DOI: 10.1007/s43390-022-00611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE (1) To describe the use of multi-rod constructs (MRCs) in adult spinal deformity (ASD) surgery, (2) to report rod fractures occurring at MRC sites, and (3) to evaluate risk factors for rod fractures. METHODS A single-center, retrospective cohort study was conducted of patients undergoing ASD surgery with these inclusion criteria: minimum 2-year follow-up, MRCs used, ≥ 10-level fusion, and fused to sacrum/pelvis. The primary outcome was rod fracture. Univariate/multivariate logistic regression was performed controlling for age, kickstand rod usage, number of rods across the lumbosacral junction (LSJ), and the amount of coronal/sagittal Cobb correction. RESULTS Among 57 patients undergoing ASD surgery with MRCs, mean age was 60 ± 11 years. With respect to MRCs, 32 (56%) patients had 3 rods, 18 (32%) had 4, and 7 (12%) had 5. Rods crossing the LSJ were most often three (63%), followed by four (25%) and five (5%) rods. Nine (16%) patients experienced rod fractures with eight (89%) patients having no more than three rods crossing the LSJ. A coronal correction > 30 mm was more often seen in patients with rod fracture (p = 0.030), while an SVA correction > 50 mm was not significantly different (p = 0.608). Multivariate logistic regression revealed that the amount of coronal correction was significantly associated with rod fracture (OR 1.03, 95% CI 1.01-1.07, p = 0.044), as was achieving a coronal correction > 30 mm (OR 7.72, 95% CI 1.17-51.10, p = 0.034), with no association between the amount of sagittal correction obtained and rod fracture. CONCLUSION This study found that greater coronal correction was associated with an increased odds of rod fracture. We suggest adding at least four rods across the LSJ cephalad to the interbody fusions to avoid rod fractures in these high demand areas. LEVEL OF EVIDENCE III.
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Lee JS, Son DW, Lee SH, Sung SK, Lee SW, Song GS, Kim YH, Choi CH. Surgical outcome of minimal invasive oblique lateral interbody fusion with percutaneous pedicle screw fixation in the treatment of adult degenerative scoliosis. Medicine (Baltimore) 2022; 101:e31879. [PMID: 36482617 PMCID: PMC9726324 DOI: 10.1097/md.0000000000031879] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Oblique lateral interbody fusion is performed for lumbar spinal restoration and stabilization, without extensive paraspinal muscle damage or massive bleeding. This study aimed to confirm the radiological and clinical outcomes of minimally invasive oblique lateral interbody fusion (OLIF) with percutaneous pedicle screw fixation (PPSF) as treatment for adult degenerative lumbar scoliosis. Medical records of 40 patients with degenerative lumbar spinal deformities who underwent selective OLIF and PPSF at our hospital between April 2018 and February 2021 were retrospectively reviewed. The study population comprised 7 male and 33 female patients aged 55-79 years. Standing radiography was performed, and the coronal cobb angle, distance between the C7 plumb line and central sacral vertical line, sagittal vertical axis, pelvic tilt, lumbar lordosis (LL), pelvic incidence (PI), and difference between PI and LL (PI-LL) were measured. Coronal scoliosis was defined as a lumbar coronal plane curve of > 15°. All patients achieved statistically significant improvements in coronal and sagittal alignment. The coronal cobb angle was corrected from 18.82° to 11.52°, and the central sacral vertical line was reduced from 18.30 mm to 15.47 mm. The sagittal vertical axis was significantly reduced from 45.95 mm to 32.72 mm. In contrast, the pelvic tilt and LL were minimally changed. For subgroup analyses, patients were divided into the convex and concave groups according to the direction of coronal curve correction. Vertebral body rotation was superior in the convex group than in the concave group. Furthermore, we checked for asymmetric facet degeneration at the upper instrumented vertebra (UIV) level at 1 year postoperatively. Of the 22 patients who underwent more than 3 level fusion surgery, 8 patients were confirmed the postoperative asymmetric facet degeneration in above UIV. Minor complications occurred in 16 patients, who recovered without any problems. Revision surgery was not performed in all cases. Minimally invasive OLIF with PPSF has a lower risk of complications and favorable surgical outcomes in patients with adult degenerative lumbar scoliosis. Access from the convex side is advantageous for the correction of the rotated vertebra. Extending the UIV level to the neutral vertebra can reduce the occurrence of postoperative asymmetric facet degeneration.
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Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- * Correspondence: Dong Wuk Son, Department of Neurosurgery, Pusan National University Yangsan Hospital, 20 Geumo-Ro, Mulgeum-eup, Yangsan-si, Gyeongsangnam-do 626-770, Korea (e-mail: )
| | - Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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