Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients.
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.
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https://hdl.handle.net/10161/17575Published Version (Please cite this version)
10.1016/j.wneu.2018.06.071Publication 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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Show full item recordScholars@Duke
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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