Adding Satellite Rods to Standard Two-rod Construct With the Use of Duet Screws: An Effective Technique to Improve Surgical Outcomes and Preventing Proximal Junctional Kyphosis in Posterior-Only Correction of Scheuermann Kyphosis. Issue 13 (1st July 2018)

• Record Type: Journal Article
• Authors: Zhu, Ze-zhang; Chen, Xi; Qiu, Yong; Chen, Zhong-hui; Li, Song; Xu, Liang; Sun, Xu
• Is Part Of: Spine. Volume 43:Issue 13(2018)
• Publication Date: 2018-07-01
• Subjects: proximal junctional kyphosis -- radiographic outcomes -- satellite rod -- Scheuermann kyphosis; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000002489
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: A retrospective matched-cohort comparative study. Objective: The aim of this study was to compare the surgical results after the use of duet screw based satellite rods and bilateral satellite rods (S-RC) versus a standard two-rod construct (2-RC) across osteotomy sites in a matched cohort with Scheuermann kyphosis (SK). Summary of Background Data: Multiple Ponte osteotomies are frequently employed to correct SK via a posterior-only approach, with a 2-RC across the osteotomy sites. Whereas, correction rate and junction problems remain as the major concerns. Methods: This study reviewed a consecutive series of patients with SK who had undergone posterior-only correction with multilevel Ponte osteotomy between 2009 and 2014 and had been followed over 24 months. Twenty-two patients receiving placement with an S-RC with the use of duet screws were identified and closely matched with 22 patients with a 2-RC in terms of age, apex, and magnitude of kyphosis. Comparisons were made with regards to deformity magnitude, correction results, complications, and clinical outcomes between the two groups. Results: No significant difference was found between groups in preoperative patient's factors (age, gender, apex, magnitude of kyphosis, and SRS-22 scores) and surgical factors (blood loss, operation time, osteotomy levels, and fused levels). Compared with the 2-RC group, the S-RC group had higher correction rate (55.4% ± 7.5% vs . 46.2% ± 5.1%, P < 0.001), less correction loss (1.0 ± 0.8° vs . 2.4 ± 1.4°, P < 0.001) during the follow-up, and higher improvement of back pain as well ( P < 0.05). None were detected with pseudarthrosis or implant failure in either group, but proximal junctional kyphosis was less frequently seen in S-RC group (1 of 22) than 2-RC group (7 of 22) ( P < 0.05). Conclusion: As a safe method, use of S-RC is effective in providing increased kyphotic correction across multiple Ponte osteotomy levels, and improving patient-reported outcomes of management satisfaction and back pain. The biomechanical benefits of stress dispersion, coupled with increased stability and weight bearing ability, make it a powerful technique preventing correction loss and proximal junctional kyphosis. Level of Evidence: 3