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

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Date
2018-09
Authors
Daniels, Alan H
DePasse, J Mason
Durand, Wesley
Hamilton, D Kojo
Passias, Peter
Kim, Han Jo
Protopsaltis, Themistocles
Reid, Daniel BC
LaFage, Virginie
Smith, Justin S
Shaffrey, Christopher
Gupta, Munish
Klineberg, Eric
Schwab, Frank
Burton, Doug
Bess, Shay
Ames, Christopher
Hart, Robert A
International Spine Study Group
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Abstract
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.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.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.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.
Type
Journal article
Subject
International Spine Study Group
Permalink
https://hdl.handle.net/10161/17575
Published Version (Please cite this version)
10.1016/j.wneu.2018.06.071
Publication Info
Daniels, Alan H; DePasse, J Mason; Durand, Wesley; Hamilton, D Kojo; Passias, Peter; Kim, Han Jo; ... International Spine Study Group (2018). Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients. World neurosurgery, 117. pp. e530-e537. 10.1016/j.wneu.2018.06.071. Retrieved from https://hdl.handle.net/10161/17575.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Shaffrey

Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery
I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex s
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