broken rod in spinal fusion

Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal J Neurosurg Spine 2013;18:3339. Smith JS, Shaffrey CI, Ames CP, et al. Spinal fusion can fail if there is not enough support to hold the spine while it is fusing. Visit www.wkauthorservices.com to learn more about creating infographics, videos and other features that can help increase your article's exposure., Keywords Domino connectors were added during the subsequent PSOs to connect to original instrumentation. The patient underwent reoperation for replacement of the broken rods, adjustment of the occipitocervical angle, maintenance of the bone graft bed, and fusion. Tensile forces through the posterior graft cause bone resorption and reduce the chance of obtaining solid fusion.[24]. Good Luck! Instrumentation variables not meeting significance included screw company, rod company, cement use, pre-contoured vs. straight rods, rod material, rod size, screw density, standard connectors vs. presence of other connectors, Table3. PubMed With consideration of the limitations in our study, incidence of rod fracture may be decreased by: 1) pursuing all means to avoid post-operative pseudarthrosis 2) use the smallest sagittal rod contour possible while providing adequate correction, in particular <60 3) decrease use of domino and/or parallel rod connectors when possible 4) if unnecessary, do not implement pelvic fixation. CT scans showed solid osseous fusion across the entire construct. What to Do If Spine Hardware Breaks - The Spine Institute CSR Provided by the Springer Nature SharedIt content-sharing initiative. Our study found no significant impact of patient demographics or baseline characteristics on the RF or CSRF risk. Clinical review of patients with broken Harrington rods - PubMed We present the case of a 32-year-old woman who was diagnosed with BI and AAD. Following risk factor analysis, statistically significant risk factors for RF were obtained: fusion construct crossing 2 spine junctions, sagittal rod contour >60, presence of dominos and/or parallel connectors at date of fracture, and pseudarthrosis at 1year follow-up. Typically, symptoms include: At BSSNY, we can help patients whose spinal hardware has fractured or broken. However, pelvic fixation alone has not been previously described as having association with RF. Revision surgery after rod breakage in a patient with occipitocervical Dick JC, Bourgeault CA. 40 Year Follow-Up After Harrington Rod Surgery - SRS 8600 Rockville Pike A biomechanical comparison. Some of these variables are thought to have an association with instrumentation failure by increasing construct strain and include under-corrected sagittal vertical axis (SVA) (OR=17.5) [29], number of instrumented vertebra (OR=2.2311.46 depending on number of levels) [14], and fusion across transitional spine junctions such as the lumbosacral junction (OR=2.8) [14, 30]. Revision surgery for non-union in adult spinal deformity. Seventy-five patients (50 female; average age, 59) met strict inclusion/exclusion criteria and follow-up of 1year. Radiographic characteristics listed above were measured with facilitation of Surgimap surgical planning software (Nemaris Inc, New York, NY) on previously obtained longstanding scoliosis x-rays. As a result, one PSO can achieve greater correction (3040) than a single SPO (approximately 10) [913]. Statistically significant risk for the CSRF subset was fusion to the pelvis and pseudarthrosis at 1year follow-up. The following factors have significant association with the risk of rod fractures after posterior instrumented adult spinal deformity correction with osteotomy: pseudarthrosis at 1 year follow-up, sagittal rod contour >60, presence of dominos and/or parallel connectors at date of fracture, and fusion construct crossing 2 junctions. Further, repeated bending or rod contouring to an extreme angle has been hypothesized to decrease rod fatigue strength [2025]. Nearly one-half of these patients noted worsening pain, Okamoto T, Neo M, Fujibayashi S, et al. According to the authors experience, both insufficient correction of the sagittal plane and great instability at the PSO leveldue to the combination of posterior bony discontinuity and anterior mechanical imbalancemay create a massive concentration of stress, causing fatigue fracture of the implant. Measurement of a posterior. 1a. Quantified risk pertaining to these factors has not been published in prior studies. Whats the Difference Between Vertebroplasty and Kyphoplasty? For more information, please refer to our Privacy Policy. This patient had two subsequent PSO operations after the original PSO operation. The increasingly severe neck pain (not due to trauma), however, seriously affected the patient's quality of life after 31 months postsurgery. Buchowski JM, Bridwell KH, Lenke LG, Kuhns CA, Lehman Jr RA, Kim YJ, et al. The manuscript submitted does not contain information about medical device(s)/drug(s). Spine J. [16]. your express consent. No funds were received in support of this work. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Charosky S, Guigui P, Blamoutier A, Roussouly P, Chopin D. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients. First, pelvic fixation may be a confounder to fusion across the lumbosacral junction of the spine, as pelvic fixation can only be present in those with fusion across the lumbosacral junction. The O-C2 angle established at occipito- cervical fusion dictates the patient's destiny in terms of postoperative dyspnea and/or dysphagia. Multiple authors have described increased complications [4, 6, 1416], pseudarthrosis [3, 4, 14, 15, 17], and instrumentation failure including rod fracture (RF) in PSO patients [4, 6, 14, 18]. When the same variables were assessed in the 4 CSRFs, only two statistically significant risk factors were noted: fusion to pelvis (P=0.05) and pseudarthrosis at 1year follow-up (OR=50.3, CI: 4.2; 598.8, P<0.01), Table5. Pertaining to metal type and rod diameter, studies have either found no statistically significant differences or have published conflicting results [18, 19]. [10]. Wang et al[25] have indicated that the position of fixation of the OC2A, to maintain the balance of the craniocervical region and decrease the long-term effects on the middle and lower cervical vertebrae, should be in the range of 9 to 22 degrees during occipitocervical fusion. CSRFs are often accompanied with radiographic signs of pseudarthrosis, new symptoms such as pain or radiculopathy, or resulting in loss of correction [18], while non-CSRFs by definition arent associated with patient symptoms or loss of correction. Please try again soon. Rod fracture in adult spinal deformity surgery fused to the sacrum: prevalence, risk factors, and impact on health-related quality of life in 526 patients. [19]. The aging population, combined with an increasing number of spine fusion procedures, is increasing the prevalence of ASD [1, 2]. Back pain after back surgery: The SI joint and adjacent segment disease 2013;72:27682. [23]. Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, et al. There is a lack of information in the literature on this subject. Our overall post-PSO RF incidence of 16.2% is comparable to what has been previously described, but our post-PSO CSRF rate of 8.1% is approximately 1/2 the rate of what has been previous reported [18]. Seventy-five patients were left for analysis including 50 female and 25 male, mean age was 59 (range, 2482; SD, 12.9), Table1. Dr. Ali sometimes sees spondylolisthesisa problem in which one vertebra (bone) slips onto another, causing pain. Your message has been successfully sent to your colleague. Revision surgery after rod breakage in a patient with : Medicine In our opinion, a nonideal angle of the OC2A and/or POCA, establishing occipitalcervical imbalance and a concentration of stress, was the most likely reason for the rod breakage in our patient. The specific type of bone grafting was not analyzed; Instrumentation variables: manufacturer; screws, polyaxial or monoaxial; rods, precontoured or straight; rod material; rod diameter; pedicle screw density, described as complete or incomplete missing one or more pedicle screws at available locations along construct; type of rod connectors, standard vs. all others including de-rotation connectors; presence of interbody support - including interbody allograft/autograft, titanium or PEEK cages, anterior plating, axial lumbar interbody fusion, and/or lateral mass screws postoperatively; sagittal rod contour angle; location of apex of rod bend; crosslink and domino/parallel-connector number and location. Recent advancements in spine surgery have allowed some patients who need lumbar fusion to avoid metal rods and pedicle screws being placed in their spine following a laminectomy. Google Scholar. However, PSOs have a couple factors that may increase rod strain including absence of pedicle screws at PSO level and greater degree of correction obtained with PSO vs. SPO. Of note, immediate postoperative films showed 2cm SVA that increased to 10cm before second PSO and remained at 10cm before third PSO. Epub 2022 Feb 22. Additionally, 9 patients were excluded based on a subsequent operation during first postoperative year for reasons other than rod fracture. Epub 2021 Mar 16. Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 12631 E. 17th Avenue B202, Aurora, CO, 80045, USA, Cameron Barton,Andriy Noshchenko,Vikas Patel,Christopher Cain,Christopher Kleck&Evalina Burger, You can also search for this author in Late Complications of Displaced Thoracolumbar Fusion Instrumentation Brain and Spine Surgeons of New York 4 Westchester Park Drive, 4th Floor White Plains, New York 10604 914-948-8448, Ezriel Kornel, MD 215 East 77th Street New York, New York 10075 212-279-3700, 10 Waldron Avenue Nyack, NY 10960 845-228-8955, One Blachley Road Chelsea Piers Stamford, Connecticut 06902 203-276-8484, 775 North Broadway, Suite 520 Sleepy Hollow, NY 10591 914-366-1144, 2022 Brain and Spine Surgeons of New York. Abstract. Preventing movement helps to prevent pain. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. (B, C) Imaging data from 13-month follow-up after the first surgery. Charosky S, Moreno P, Maxy P. Instability and instrumentation failures after a PSO: a finite element analysis. Yamato Y, Hasegawa T, Yoshida G, Banno T, Oe S, Arima H, Mihara Y, Ushirozako H, Yamada T, Watanabe Y, Ide K, Nakai K, Kurosu K, Matsuyama Y. Asian Spine J. Google Scholar. Suitable rods were molded into a normal spinal curve using a plate bender. Extrinsic factors can be divided into several previously described biomechanical notions. Relation between alignments of upper and subaxial cervical spine: a radiological study. This thought was based on the possibility that the original rods could have been replaced or subject to different additional stressors (e.g., addition of iliac bolts during subsequent operation) than were primarily documented. Spine (Phila Pa 1976). Eleven of 17 patients were<2years post-operation (obtaining a range of follow-up from 1220months) while the remaining 6 of 17 were considered true lost to follow-up (LTFU). Clin Orthop Relat Res. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). At the 31-month follow-up after her first operation, the patient complained of severe neck pain and limitation of motion, suggesting rod breakage. Relationship between the alignment of the occipitoaxial and subaxial cervical spine in patients with congenital atlantoxial dislocations. AN participated in the study design, provided statistical analysis, and helped draft the manuscript. Data is temporarily unavailable. Patients with radiographic fusion were evaluated for subsequent rod fracture. Fractured Spinal Hardware Symptoms & Treatments - BSSNY Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after. Many spine surgeries require the use of hardware to give the spine added strength and stability. Do I have a legal case of defective hardware for spinal fusion, with no A synthetic testing model. 2010 Oct 15;35(22):E1199-203. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. In addition, there was no cervical kyphosis or instability at follow-up after the revision surgery. Summary of Background Data. Parameters and clinical efficacy of patient. Conclusions: Static and fatigue biomechanical properties of anterior thoracolumbar instrumentation systems.

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