Is lower screw density associated with mechanical complications in adult spinal deformity surgery?

被引：0
作者：
Chanbour, Hani [1 ]
LaBarge, Matthew E. [2 ]
Jonzzon, Soren [1 ]
Roth, Steven G. [1 ]
Abtahi, Amir M. [1 ,2 ]
Stephens, Byron F. [1 ,2 ]
Zuckerman, Scott L. [1 ,2 ]
机构：
[1] Vanderbilt Univ, Med Ctr, Dept Neurol Surg, Med Ctr North T 4224, Nashville, TN 37212 USA
[2] Vanderbilt Univ, Dept Orthoped Surg, Med Ctr, Nashville, TN 37212 USA
来源：
SPINE DEFORMITY | 2023年 / 11卷 / 04期
关键词：
Adult spinal deformity; Mechanical complications; Screw density; Proximal junctional kyphosis; Rod fracture; Pseudarthrosis; ADOLESCENT IDIOPATHIC SCOLIOSIS; PROXIMAL JUNCTIONAL KYPHOSIS; PEDICLE-SCREW; THORACIC KYPHOSIS; FUSION; INSTRUMENTATION; OUTCOMES; RATES;
D O I：
10.1007/s43390-023-00671-4
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
PurposeTo assess the impact of screw density on: (1) rod fracture/pseudarthrosis, (2) proximal/distal junctional kyphosis/failure (PJK/DJK/PJF), and (3) deformity correction judged by sagittal vertical axis (SVA) and T1-pelvic angle (T1PA).MethodsA single-center, retrospective cohort study of patients undergoing adult spinal deformity (ASD) surgery from 2013 to 2017 was undertaken. Screw density was calculated by dividing the number of screws placed by the total instrumented levels. Screw density was then dichotomized at our calculated mean density to >= 1.65 and < 1.65. Outcomes consisted of mechanical complications and the amount of correction obtained.Results145 patients underwent ASD surgery with 2-year follow-up. Mean screw density (range) was 1.6 +/- 0.3 (1.00-2.00). The most common levels with missing screws were L2 (n = 59, 40.7%), L3 (n = 57, 39.3%) and L1 (n = 51, 35.2%), located mainly along the concavity in 113(80.0%) patients and apices in 98 (67.6%) patients. Rod fracture/pseudarthrosis: 23/32 (71.8%) patients with rod fracture and 35/46 (76.0%) with pseudarthrosis had missing screws within two levels of the rod fracture/pseudarthrosis. Logistic regression showed no significant association between screw density and rod fracture/pseudarthrosis. PJK/F: 15/47 (31.9%) patients with PJK and 9/30 (30.0%) with PJF had missing screws within three levels of the upper instrumented vertebra (UIV). Logistic regression showed no significant association between screws density and PJK/F. Correction obtained: linear regression failed to show any significant association between screw density and SVA or T1PA correction.ConclusionThese findings showed that no significant association was found between screw density and mechanical complications or the amount of correction obtained, though approximately 3 out of 4 patients with rod fracture/pseudarthrosis had missing screws at or within two levels of the pathology. The prevention of mechanical complications is likely multifactorial and subject to both patient's characteristics and surgical techniques.
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页码：1009 / 1018
页数：10
相关论文
共 33 条
[1]   Comparison of rod fracture rates in long spinal deformity constructs after transforaminal versus anterior lumbar interbody fusions: a single-institution analysis [J].
Adogwa, Owoicho ;
Buchowski, Jacob M. ;
Lenke, Lawrence G. ;
Shlykov, Maksim A. ;
El Dafrawy, Mostafa ;
Lertudomphonwanit, Thamrong ;
Obey, Mitchel R. ;
Koscso, Jonathan ;
Gupta, Munish C. ;
Bridwell, Keith H. .
JOURNAL OF NEUROSURGERY-SPINE, 2020, 32 (01) :42-49
[2]   Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series [J].
Barton, Cameron ;
Noshchenko, Andriy ;
Patel, Vikas ;
Cain, Christopher ;
Kleck, Christopher ;
Burger, Evalina .
SCOLIOSIS AND SPINAL DISORDERS, 2015, 10
[3]   Minimum 10 years follow-up surgical results of adolescent idiopathic scoliosis patients treated with TSRH instrumentation [J].
Benli, I. Teoman ;
Ates, Buelent ;
Akalin, Serdar ;
Citak, Mehmet ;
Kaya, Alper ;
Alanay, Ahmet .
EUROPEAN SPINE JOURNAL, 2007, 16 (03) :381-391
[4]   Correction of Lenke 5 Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation Does Implant Density Influence the Correction? [J].
Chen, Jiayu ;
Yang, Changwei ;
Ran, Bo ;
Wang, Yunhua ;
Wang, Chao ;
Zhu, Xiaodong ;
Bai, Yushu ;
Li, Ming .
SPINE, 2013, 38 (15) :E946-E951
[5]   Adult spinal deformity surgery - Complications and outcomes in patients over age 60 [J].
Daubs, Michael D. ;
Lenke, Lawrence G. ;
Cheh, Gene ;
Stobbs, Georgia ;
Bridwell, Keith H. .
SPINE, 2007, 32 (20) :2238-2244
[6]   Adult spinal deformity [J].
Diebo, Bassel G. ;
Shah, Neil, V ;
Boachie-Adjei, Oheneba ;
Zhu, Feng ;
Rothenfluh, Dominique A. ;
Paulino, Carl B. ;
Schwab, Frank J. ;
Lafage, Virgirlie .
LANCET, 2019, 394 (10193) :160-172
[7]   Pseudarthrosis and Rod Fracture Rates After Transforaminal Lumbar Interbody Fusion at the Caudal Levels of Long Constructs for Adult Spinal Deformity Surgery [J].
Dinizo, Michael ;
Srisanguan, Karnmanee ;
Dolgalev, Igor ;
Errico, Thomas J. ;
Raman, Tina .
WORLD NEUROSURGERY, 2021, 155 :E605-E611
[8]   Low-Density Pedicle Screw Constructs Are Associated with Lower Incidence of Proximal Junctional Failure in Adult Spinal Deformity Surgery [J].
Durand, Wesley M. ;
DiSilvestro, Kevin J. ;
Kim, Han Jo ;
Hamilton, David K. ;
Lafage, Renaud ;
Passias, Peter G. ;
Protopsaltis, Themistocles S. ;
Lafage, Virginie ;
Smith, Justin S. ;
Shaffrey, Christopher, I ;
Gupta, Munish C. ;
Klineberg, Eric O. ;
Schwab, Frank J. ;
Gum, Jeffrey L. ;
Mundis, Gregory M., Jr. ;
Eastlack, Robert K. ;
Kebaish, Khaled M. ;
Soroceanu, Alexandra ;
Hostin, Richard A., Jr. ;
Burton, Douglas C. ;
Bess, Shay ;
Ames, Christopher P. ;
Hart, Robert A. ;
Daniels, Alan H. .
SPINE, 2022, 47 (06) :463-469
[9]   Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion - Incidence, outcomes, and risk factor analysis [J].
Glattes, RC ;
Bridwell, KH ;
Lenke, LG ;
Kim, YJ ;
Rinella, A ;
Edwards, C .
SPINE, 2005, 30 (14) :1643-1649
[10]   Evaluation and treatment of adult spinal deformity - Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004 [J].
Heary, RF .
JOURNAL OF NEUROSURGERY-SPINE, 2004, 1 (01) :9-18
1234