Multi-Rod Constructs Can Increase the Incidence of Iliac Screw Loosening after Surgery for Adult Spinal Deformity

Asian Spine Journal

Sho Kobayashi¹  Tatsuya Yasuda²  Daisuke Togawa²  Tomohiro Banno²  Yuki Mihara²  Tomohiko Hasegawa²  Go Yoshida²  Yukihiro Matsuyama²  Hideyuki Arima²  Shin Oe²  Hiroki Ushirozako²  Yu Yamato² 

[1] Department of Orthopaedic Surgery, Hamamatsu Medical Center, Hamamatsu, Japan;Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan;

关键词: Adult spinal deformity;    Complication;    Iliac screw;    Multi-rod construct;    Screw loosening;    Adult spinal deformity;   

DOI  :  10.31616/asj.2018.0209

来源: DOAJ

【 摘 要 】

Study Design A retrospective study. Purpose To investigate the incidence of iliac screw loosening with a two-rod vs. multi-rod construct and the effect on clinical and radiographic outcomes after surgery for adult spinal deformity (ASD). Overview of Literature Multi-rod construct is useful for preventing rod fracture in ASD surgery. However, limited information is available regarding the incidence of iliac screw loosening after corrective fusion surgery using a multi-rod construct. Methods Total 106 patients with ASD (24 men and 82 women; mean age, 68 years) who underwent corrective fusion surgery using bilateral iliac screws and were followed up for at least 1 year were reviewed. The following variables were compared between patients who underwent surgery with a two-rod and multi-rod construct: age, sex, bone mineral density (BMD), fusion level, high-grade osteotomy, L5/S interbody fusion, screw loosening (upper instrumented vertebra [UIV], S1, and iliac), rod fracture, proximal junctional kyphosis, spinopelvic parameters, and Oswestry Disability Index (ODI) score. We also compared patients with and without iliac screw loosening in the multi-rod construct group. Results Of the 106 patients, 55 underwent surgery with a conventional two-rod construct and 51 with a multi-rod construct (three rods in 16, four rods in 35). Iliac and UIV screw loosening was observed in 24 patients (21%) and 35 patients (33%), respectively. The multi-rod group showed significantly higher incidence of iliac and UIV screw loosening and lower incidence of rod fracture. Patients with iliac screw loosening had a lower BMD than those without screw loosening; however, no significant differences were observed in the spinopelvic parameters or the ODI score. Conclusions The use of multi-rod constructs led to a higher incidence of junctional screw loosening than the use of conventional two-rod constructs, especially in patients with osteoporosis. Iliac screw loosening did not affect sagittal alignment or clinical outcome in the short term.

【 授权许可】

Unknown