Assessment of Symptomatic Rod Fracture After Posterior Instrumented Fusion for Adult Spinal Deformity.

@article{Smith2012AssessmentOS,
  title={Assessment of Symptomatic Rod Fracture After Posterior Instrumented Fusion for Adult Spinal Deformity.},
  author={Justin S. Smith and Christopher I Shaffrey and Christopher P. Ames and Jason Demakakos and Kai-Ming G. Fu and Sassan Keshavarzi and Carol M Y Li and Vedat Deviren and Frank Schwab and Virginie Lafage and Shay Bess},
  journal={Neurosurgery},
  year={2012},
  volume={71 4},
  pages={862-868}
}
BACKGROUND: Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling. OBJECTIVE: To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity. METHODS: A multicenter, retrospective review of RF in adult spinal deformity was performed. Inclusion criteria were spinal deformity, age older than 18 years, and more than 5 levels posterior instrumented fusion. Rod failures were… 

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References

SHOWING 1-10 OF 22 REFERENCES

Minimum 5-Year Analysis of L5–S1 Fusion Using Sacropelvic Fixation (Bilateral S1 and Iliac Screws) for Spinal Deformity

For high-grade spondylolisthesis and long adult deformity fusions to the sacrum, a montage of bilateral S1 screws and iliac screws were effective in protecting the sacral screws from failure.

Posterior/anterior combined surgery for thoracolumbar burst fractures—posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting

Posterior/anterior combined surgery with posterior pedicle screws and hooks fixation, and reconstruction by simultaneous strut grafting and anterior decompression, achieved short segment fixation and can be a useful option for surgically treating thoracolumbar burst fractures.

Comparison of Single- and Dual-Rod Techniques for Posterior Spinal Instrumentation in the Treatment of Adolescent Idiopathic Scoliosis

Single-rod instrumentation and dual-rod constructs offered similar curve correction, blood loss, and operative time, however, single-Rod instrumentation may be more prone to implant failure when extended into the lumbar spine.

Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients : a long-term follow-up data.

Intraoperative or postoperative complications are relatively common following pedicle subtraction osteotomy, and most late-onset complications in PSO patients were related to PJK and instrumentation failure.

Thoracic Pedicle Subtraction Osteotomy for Fixed Sagittal Spinal Deformity

Thoracic PSO can be performed safely, and segmental sagittal correction appears to vary based on the region of the thoracic spine the PSO is performed, as well as regional and global spinal balance.

Biomechanical Analysis of Revision Strategies for Rod Fracture in Pedicle Subtraction Osteotomy

The results suggest that these revision strategies can restore stiffness without entire rod replacement and failure of AR stiffness restoration can be mitigated with cross-links.

Complications and Outcomes of Pedicle Subtraction Osteotomies for Fixed Sagittal Imbalance

The clinical result with pedicle subtraction osteotomy is reduced with pseudarthrosis in the thoracic or lumbar spine and subsequent breakdown adjacent to the fusion, and the results were worse and the complications were higher.

Wear and Corrosion in Retrieved Thoracolumbar Posterior Internal Fixation

Posterior thoracolumbar spine implants retrieved as part of routine clinical practice over a 2-year period were analyzed to identify wear and corrosion and wore and corrosion mainly located at the interfaces with hooks, screws, or cross-connectors.

The durability of small-diameter rods in lumbar spinal fusion.

Evaluation of postoperative radiographs revealed two instances of rod failure that occurred more than 24 months after operation among 85 cases of pedicle screw instrumentation followed for an average of 32 months, suggesting the benefits of a small-diameter rod can be obtained without an increased incidence of rods failure during the initial healing period.

Biomechanical analysis of cervicothoracic junction osteotomy in cadaveric model of ankylosing spondylitis: effect of rod material and diameter.

The results of this study suggest that 3.5-mm CoCr rods are optimal for achieving the most rigid construct in opening wedge osteotomy in the cervicothoracic region of an AS model, and additional posterior stability achieved with CoCr may decrease the need for additional anterior procedures.