Influence of implant density on mechanical complications in adult spinal deformity surgery.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

European Spine Journal Pub Date : 2024-12-01 Epub Date: 2024-10-28 DOI:10.1007/s00586-024-08543-9

Yann Philippe Charles, François Severac, Susana Núñez-Pereira, Sleiman Haddad, Lluis Vila, Ferran Pellisé, Ibrahim Obeid, Louis Boissière, Caglar Yilgor, Altug Yucekul, Ahmet Alanay, Frank Kleinstück, Markus Loibl, Alejandro Gómez-Rice, Riccardo Raganato, Francisco Javier Sánchez Perez-Grueso, Javier Pizones

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引用次数: 0

Abstract

Objective: The purpose was to analyze how rod characteristics, screw density and cages influence the incidence of mechanical complications compared to patient-related factors and alignment in adult spinal deformity instrumented T9-T11 to pelvis.

Methods: Register data of 302 patients was analyzed. Relative lumbar lordosis (RLL) and relative sagittal alignment (RSA) was measured. Surgical data included rod characteristics, pedicle screw density and interbody cages. Univariate and multivariate logistic regression models were used.

Results: Pseudarthrosis occurred in 24.1%. On univariate analysis Odds Ratio (OR) was 0.74 for ≥ 3 cages (p = 0.452), 0.48 for 4 rods (p = 0.008), 4.30 for high screw density (p = 0.001). Patient-related factors were non-significant. Multivariate OR was 0.59 for 4 rods (p = 0.084) and 4.67 for high screw density (p = 0.005). PJK/PJF occurred in 19.2%. Age > 60 had an OR 2.83 (p = 0.023), postoperative RSA malaligned OR 2.84 (p = 0.030), severely malaligned OR 6.54 (p < 0.001). Implant characteristics were non-significant. Multivariate OR was 1.26 for age > 60 (p = 0.657), 2.32 for malaligned RSA (p = 0.097), 5.69 for severely malaligned RSA (p = 0.001). Screw loosening occurred in 8.9%. Univariate OR was 0.95 for ≥ 3 cages (p = 0.920), 1.64 for 4 rods (p = 0.235), 0.25 for high screw density 1.5-2 (p = 0.011). Patient-related factors were non-significant. Multivariate OR for high screw density was 0.23 (p = 0.022).

Conclusion: Four rods decrease the pseudarthrosis risk. Cages have a secondary role. High screw density doesn't prevent from pseudarthrosis. Postoperative malalignment is the main PJK/PJF risk factor. Age plays a secondary role. Implant characteristics have a minor influence. High screw density constructs have a lower risk for screw loosening.

Level of evidence: 3-Retrospective register study.

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植入物密度对成人脊柱畸形手术机械并发症的影响。

目的目的是分析在T9-T11至骨盆的成人脊柱畸形器械治疗中，与患者相关因素和对线相比，棒的特性、螺钉密度和保持架如何影响机械并发症的发生率：分析了 302 名患者的登记数据。方法：分析了 302 名患者的登记数据，测量了相对腰椎前凸（RLL）和相对矢状对齐度（RSA）。手术数据包括骨棒特征、椎弓根螺钉密度和椎体间固定架。采用单变量和多变量逻辑回归模型：结果：假关节发生率为24.1%。单变量分析显示，≥3个椎体间套管的奥德比（OR）为0.74（P = 0.452），4根椎体间套管的奥德比（OR）为0.48（P = 0.008），高螺钉密度的奥德比（OR）为4.30（P = 0.001）。与患者相关的因素不显著。4根螺杆的多变量OR为0.59（p = 0.084），高螺钉密度的多变量OR为4.67（p = 0.005）。PJK/PJF发生率为19.2%。年龄大于60岁的OR值为2.83（p = 0.023），术后RSA错位的OR值为2.84（p = 0.030），严重错位的OR值为6.54（p 60（p = 0.657），RSA错位的OR值为2.32（p = 0.097），严重错位的OR值为5.69（p = 0.001）。螺钉松动发生率为 8.9%。单变量OR值为：≥3个椎笼为0.95（p = 0.920），4根为1.64（p = 0.235），高螺钉密度1.5-2为0.25（p = 0.011）。患者相关因素不显著。高螺钉密度的多变量OR为0.23（p = 0.022）：结论：四根杆可降低假关节风险。结论：四根杆可降低假性关节风险，保持架的作用次之。高螺钉密度并不能防止假关节的发生。术后对位不正是 PJK/PJF 的主要风险因素。年龄是次要因素。植入物的特性影响较小。高螺钉密度结构的螺钉松动风险较低：3-回顾性登记研究。

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

European Spine Journal 医学-临床神经学

CiteScore

4.80

自引率

10.70%

发文量

373

审稿时长

2-4 weeks

期刊介绍： "European Spine Journal" is a publication founded in response to the increasing trend toward specialization in spinal surgery and spinal pathology in general. The Journal is devoted to all spine related disciplines, including functional and surgical anatomy of the spine, biomechanics and pathophysiology, diagnostic procedures, and neurology, surgery and outcomes. The aim of "European Spine Journal" is to support the further development of highly innovative spine treatments including but not restricted to surgery and to provide an integrated and balanced view of diagnostic, research and treatment procedures as well as outcomes that will enhance effective collaboration among specialists worldwide. The “European Spine Journal” also participates in education by means of videos, interactive meetings and the endorsement of educative efforts. Official publication of EUROSPINE, The Spine Society of Europe