Rod fractures in thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients.

dc.contributor.author

Sardi, Juan Pablo

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Lazaro, Bruno

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Smith, Justin S

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Kelly, Michael P

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Dial, Brian

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Hills, Jeffrey

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Yanik, Elizabeth L

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Gupta, Munish

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Baldus, Christine R

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Yen, Chun Po

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Lafage, Virginie

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Ames, Christopher P

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Bess, Shay

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Schwab, Frank

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Shaffrey, Christopher I

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Bridwell, Keith H

dc.date.accessioned

2023-06-15T16:31:10Z

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2023-06-15T16:31:10Z

dc.date.issued

2023-02

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2023-06-15T16:31:09Z

dc.description.abstract

Objective

Previous reports of rod fracture (RF) in adult spinal deformity are limited by heterogeneous cohorts, low follow-up rates, and relatively short follow-up durations. Since the majority of RFs present > 2 years after surgery, true occurrence and revision rates remain unclear. The objectives of this study were to better understand the risk factors for RF and assess its occurrence and revision rates following primary thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis (ASLS) in a prospective series with long-term follow-up.

Methods

Patient records were obtained from the Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) database, an NIH-sponsored multicenter, prospective study. Inclusion criteria were as follows: patients aged 40-80 years undergoing primary surgeries for ASLS (Cobb angle ≥ 30° and Oswestry Disability Index ≥ 20 or Scoliosis Research Society-22r ≤ 4.0 in pain, function, and/or self-image) with instrumented fusion of ≥ 7 levels that included the sacrum/pelvis. Patients with and without RF were compared to assess risk factors for RF and revision surgery.

Results

Inclusion criteria were met by 160 patients (median age 62 years, IQR 55.7-67.9 years). At a median follow-up of 5.1 years (IQR 3.8-6.6 years), there were 92 RFs in 62 patients (38.8%). The median time to RF was 3.0 years (IQR 1.9-4.54 years), and 73% occurred > 2 years following surgery. Based on Kaplan-Meier analyses, estimated RF rates at 2, 4, 5, and 8 years after surgery were 11%, 24%, 35%, and 49%, respectively. Baseline radiographic, clinical, and demographic characteristics were similar between patients with and without RF. In Cox regression models, greater postoperative pelvic tilt (HR 1.895, 95% CI 1.196-3.002, p = 0.0065) and greater estimated blood loss (HR 1.02, 95% CI 1.005-1.036, p = 0.0088) were associated with increased risk of RF. Thirty-eight patients (61% of all RFs) underwent revision surgery. Bilateral RF was predictive of revision surgery (HR 3.52, 95% CI 1.8-6.9, p = 0.0002), while patients with unilateral nondisplaced RFs were less likely to require revision (HR 0.39, 95% CI 0.18-0.84, p = 0.016).

Conclusions

This study provides what is to the authors' knowledge the highest-quality data to date on RF rates following ASLS surgery. At a median follow-up of 5.1 years, 38.8% of patients had at least one RF. Estimated RF rates at 2, 4, 5, and 8 years after surgery were 11%, 24%, 35%, and 49%, respectively. Greater estimated blood loss and postoperative pelvic tilt were significant risk factors for RF. These findings emphasize the importance of long-term follow-up to realize the true prevalence and cumulative incidence of RF.
dc.identifier.issn

1547-5654

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1547-5646

dc.identifier.uri

https://hdl.handle.net/10161/27973

dc.language

eng

dc.publisher

Journal of Neurosurgery Publishing Group (JNSPG)

dc.relation.ispartof

Journal of neurosurgery. Spine

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10.3171/2022.8.spine22423

dc.subject

Pelvis

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Lumbar Vertebrae

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Sacrum

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Thoracic Vertebrae

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Humans

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Scoliosis

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Treatment Outcome

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Spinal Fusion

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Retrospective Studies

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Follow-Up Studies

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Prospective Studies

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Adult

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Middle Aged

dc.title

Rod fractures in thoracolumbar fusions to the sacrum/pelvis for adult symptomatic lumbar scoliosis: long-term follow-up of a prospective, multicenter cohort of 160 patients.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

217

pubs.end-page

229

pubs.issue

2

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Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

38

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