Use of the kickstand rod improves coronal alignment and maintains correction compared to control at 2 year follow-up.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2024-08-20 DOI:10.1007/s43390-024-00950-8

Fthimnir M Hassan, Anson Bautista, Justin L Reyes, Varun Puvanesarajah, Josephine R Coury, Sarthak Mohanty, Joseph M Lombardi, Zeeshan M Sardar, Ronald A Lehman, Lawrence G Lenke

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Abstract

Purpose: To assess and compare coronal alignment correction at 2 year follow-up in adult spinal deformity (ASD) patients treated with and without the kickstand rod (KSR) construct.

Methods: ASD patients who underwent posterior spinal fusion at a single-center with a preoperative coronal vertical axis (CVA) ≥ 3 cm and a minimum of 2 year clinical and radiographic follow-up were identified. Patients were divided into two groups: those treated with a KSR and those who were not. Patients were propensity score-matched (PSM) controlling for preoperative CVA and instrumented levels to limit potential biases that my influence the magnitude of coronal correction.

Results: One hundred sixteen patients were identified (KSR = 42, Control = 74). There were no statistically significant differences in patient characteristics (p > 0.05). At baseline, the control group presented with a greater LS curve (29.0 ± 19.6 vs. 21.5 ± 10.8, p = 0.0191) while the KSR group presented with a greater CVA (6.3 ± 3.6 vs. 4.5 ± 1.8, p = 0.0036). After 40 PSM pairs were generated, there were no statistically significant differences in baseline patient and radiographic characteristics. Within the matched cohorts, the KSR group demonstrated greater CVA correction at 1 year (4.7 ± 2.4 cm vs. 2.9 ± 2.2 cm, p = 0.0012) and 2 year follow-up (4.7 ± 2.6 cm vs. 3.1 ± 2.6 cm, p = 0.0020) resulting in less coronal malalignment one (1.5 ± 1.3 cm vs. 2.4 ± 1.6 cm, p = 0.0056) and 2 year follow-up (1.6 ± 1.0 vs. 2.5 ± 1.5 cm, p = 0.0110). No statistically significant differences in PROMs, asymptomatic mechanical complications, reoperations for non-mechanical complications were observed at 2 year follow-up. However, the KSR group experienced a lesser rate of mechanical complications requiring reoperations (7.1% vs. 24.3%. OR = 0.15 [0.03-0.72], p = 0.0174).

Conclusions: Patients treated with a KSR had a greater amount of coronal realignment at the 2 year follow-up time period and reported less mechanical complications requiring reoperation. However, 2 year patient-reported outcomes were similar between the two groups.

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与对照组相比，使用脚架杆可改善冠状对齐情况，并在 2 年的随访中保持矫正效果。

目的：评估并比较使用和未使用踢脚杆（KSR）结构治疗的成人脊柱畸形（ASD）患者随访 2 年后的冠状位校正情况：方法：确定在单个中心接受脊柱后路融合术的 ASD 患者，这些患者术前冠状垂直轴（CVA）≥ 3 厘米，并接受至少 2 年的临床和影像学随访。患者分为两组：接受 KSR 治疗的患者和未接受 KSR 治疗的患者。对患者进行倾向评分匹配（PSM），控制术前 CVA 和器械水平，以限制可能影响冠状位矫正幅度的潜在偏差：共确定了 116 名患者（KSR = 42，对照组 = 74）。患者特征无明显统计学差异（P>0.05）。基线时，对照组的 LS 曲线较大（29.0 ± 19.6 vs. 21.5 ± 10.8，p = 0.0191），而 KSR 组的 CVA 曲线较大（6.3 ± 3.6 vs. 4.5 ± 1.8，p = 0.0036）。在生成 40 对 PSM 后，患者的基线和放射学特征在统计学上没有显著差异。在配对队列中，KSR 组在 1 年（4.7 ± 2.4 厘米 vs. 2.9 ± 2.2 厘米，p = 0.0012）和 2 年随访（4.7 ± 2.6 厘米 vs. 3.1 ± 2.6 cm，p = 0.0020），导致冠状面错位减少（1.5 ± 1.3 cm vs. 2.4 ± 1.6 cm，p = 0.0056），随访 2 年（1.6 ± 1.0 vs. 2.5 ± 1.5 cm，p = 0.0110）。随访 2 年后，在 PROMs、无症状机械并发症、非机械并发症的再手术方面未观察到有统计学意义的差异。然而，KSR组需要再次手术的机械并发症发生率较低（7.1% vs. 24.3%，OR = 0.15 [0.03-0.72]，p = 0.0174）：结论：接受KSR治疗的患者在2年随访期间的冠状位重新对齐率更高，需要再次手术的机械并发症更少。然而，两组患者的两年随访结果相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.

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