Axial rod slip at the end-of-construct screw in scoliosis surgery: relevance, occurrence and prevention.

IF 1.6 Q3 CLINICAL NEUROLOGY
Spine deformity Pub Date : 2024-11-01 Epub Date: 2024-08-20 DOI:10.1007/s43390-024-00925-9
T P Schlösser, I Blaauw, M R van der Valk, Guido van Solinge, C Faber, M C Kruyt
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引用次数: 0

Abstract

Purpose: Despite standardized biomechanical tests for spinal implants, we recently recognized pedicle screw failure to maintain the rod fixated as a clinical concern in scoliosis surgery. This occurrence study investigates the risk and magnitude of axial rod slip (ARS), its relation with technique and preventive measures.

Methods: Retrospective multicenter review of all primary scoliosis cases (2018-2020) with > 1 year FU from three centers, instrumented with uniplanar screws and 5.5 mm CoCr rods (Mesa 2, Stryker Corporation, Kalamazoo, MI, USA). ARS was defined as > 1 mm change in residual distal rod length from the screw in the lowest instrumented vertebra (LIV) and assessed by two independent observers. Slip distance, direction, relation to distal screw density and time of observation were recorded, as well as the effect of ARS on caudal curve increase. To prevent slip, more recent patients were instrumented with a different end-of-construct screw (Reline, NuVasive Inc. San Diego, CA, USA) and analyzed for comparison.

Results: ARS risk was 27% (56/205) with a distance of 3.6 ± 2.2 mm, predominantly convex. 42% occurred before 4 months, the rest before 1 year. The caudal curve substantially increased three times more often in patients with ARS. Interobserver reliability was high and slip was in the expected direction. ARS was unrelated to distal screw density. Remarkable variation in ARS rates (53%, 31%, 13%) existed between the centers, while there was no difference in mean screw density (≈1.3 screws/level) or curve correction (≈60%). Revision surgery for ARS was required in 2.9% (6/207). Using the different end-of-construct screw, ARS risk was only 2% (1/56) and no revisions were required.

Conclusion: This study demonstrates the prevalence of axial rod slip at the end of construct in scoliosis surgery and its clinical relevance. While minimal ARS can be subclinical, ARS should not be mistaken for adding on. The most severe ARS predominantly occurred convex at the high-loaded distal screw when L3 was the LIV. Longer constructs (LIV L3 or L4) have a higher risk of ARS. The minimal risk of ARS with another end-of-construct screw underscores the influence of screw type on ARS occurrence in our series. Further research is essential to refine techniques and enhance patient outcomes.

脊柱侧弯手术中结构末端螺钉处的轴向杆滑脱:相关性、发生率和预防。
目的:尽管对脊柱植入物进行了标准化的生物力学测试,但我们最近发现椎弓根螺钉无法保持杆固定是脊柱侧弯手术中的一个临床问题。本研究调查了轴向杆滑脱(ARS)的风险和程度、其与技术和预防措施的关系:回顾性多中心审查三个中心所有FU>1年的原发性脊柱侧凸病例(2018-2020年),使用单平面螺钉和5.5 mm CoCr杆(Mesa 2,史赛克公司,美国密歇根州卡拉马祖)进行器械固定。ARS的定义是:从最低器械椎体(LIV)的螺钉算起,残余远端杆长度变化> 1 mm,并由两名独立观察者进行评估。记录滑脱距离、方向、与远端螺钉密度的关系和观察时间,以及ARS对尾曲线增加的影响。为防止滑脱,用不同的结构末端螺钉(Reline,NuVasive Inc:ARS风险为27%(56/205),距离为3.6 ± 2.2 mm,主要为凸面。42%发生在 4 个月前,其余发生在 1 年前。ARS患者的尾部曲线大幅增加的频率是正常人的三倍。观察者之间的可靠性很高,滑移方向符合预期。ARS与远端螺钉密度无关。各中心之间的ARS发生率存在显著差异(53%、31%、13%),而平均螺钉密度(≈1.3枚螺钉/水平)或曲线矫正率(≈60%)则没有差异。2.9%的患者(6/207)需要进行ARS翻修手术。使用不同的结构末端螺钉,ARS风险仅为2%(1/56),且无需进行翻修手术:这项研究证明了脊柱侧弯手术中结构末端轴向杆滑脱的发生率及其临床意义。虽然轻微的ARS可能是亚临床症状,但不应将ARS误认为是附加症状。当L3为LIV时,最严重的ARS主要发生在高负荷远端螺钉的凸面。较长的结构(LIV L3或L4)发生ARS的风险较高。在我们的系列研究中,使用另一颗结构末端螺钉发生ARS的风险极低,这凸显了螺钉类型对ARS发生的影响。进一步的研究对完善技术和提高患者预后至关重要。
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来源期刊
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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