Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients

International Spine Study Group

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. Methods: Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors. Results: Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60–69 years (vs. 18-49), body mass index 30–34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4%) presented with worsened pain, and 8 (21.1%) required revision at minimum 2-year follow-up. Conclusions: Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pain
Pseudarthrosis
Stainless Steel
Osteotomy
Titanium
Reoperation
Comorbidity
Body Mass Index
Multivariate Analysis
Age Groups
Obesity
Logistic Models
Databases
Surgeons

Keywords

  • Adult spinal deformity
  • ASD
  • Fusion
  • Pseudarthrosis
  • Rod Fracture

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients. / International Spine Study Group.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

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title = "Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients",
abstract = "Background: Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. Methods: Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors. Results: Of 402 patients with radiographically apparent solid fusion, 9.5{\%} (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60–69 years (vs. 18-49), body mass index 30–34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4{\%}) presented with worsened pain, and 8 (21.1{\%}) required revision at minimum 2-year follow-up. Conclusions: Rod fracture occurred in 9.5{\%} of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1{\%} required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.",
keywords = "Adult spinal deformity, ASD, Fusion, Pseudarthrosis, Rod Fracture",
author = "{International Spine Study Group} and Daniels, {Alan H.} and DePasse, {J. Mason} and Wesley Durand and Hamilton, {D. Kojo} and Peter Passias and Kim, {Han Jo} and Themistocles Protopsaltis and Reid, {Daniel B.C.} and Virginie LaFage and Smith, {Justin S.} and Christopher Shaffrey and Munish Gupta and Klineberg, {Eric Otto} and Frank Schwab and Doug Burton and Shay Bess and Christopher Ames and Hart, {Robert A.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2018.06.071",
language = "English (US)",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

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T1 - Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients

AU - International Spine Study Group

AU - Daniels, Alan H.

AU - DePasse, J. Mason

AU - Durand, Wesley

AU - Hamilton, D. Kojo

AU - Passias, Peter

AU - Kim, Han Jo

AU - Protopsaltis, Themistocles

AU - Reid, Daniel B.C.

AU - LaFage, Virginie

AU - Smith, Justin S.

AU - Shaffrey, Christopher

AU - Gupta, Munish

AU - Klineberg, Eric Otto

AU - Schwab, Frank

AU - Burton, Doug

AU - Bess, Shay

AU - Ames, Christopher

AU - Hart, Robert A.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. Methods: Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors. Results: Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60–69 years (vs. 18-49), body mass index 30–34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4%) presented with worsened pain, and 8 (21.1%) required revision at minimum 2-year follow-up. Conclusions: Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.

AB - Background: Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. Methods: Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors. Results: Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60–69 years (vs. 18-49), body mass index 30–34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4%) presented with worsened pain, and 8 (21.1%) required revision at minimum 2-year follow-up. Conclusions: Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.

KW - Adult spinal deformity

KW - ASD

KW - Fusion

KW - Pseudarthrosis

KW - Rod Fracture

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