Pedicle subtraction osteotomy in adult spinal deformity correction: Clinical and radiographic risk factors for early instrumentation failure. (December 2021)

• Record Type: Journal Article
• Authors: Penalosa, Bryan S.; Ramos, Omar; Patel, Shalin S.; Cheng, Wayne K.; Danisa, Olumide A.
• Is Part Of: Journal of clinical neuroscience. Volume 94(2021)
• Page Start: 266
• Page End: 270
• Publication Date: 2021-12
• Subjects: Adult spinal deformity -- Instrumentation failure -- Pedicle subtraction osteotomy -- Rod failure sagittal imbalance; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.08.019
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Instrumentation failure after PSO is a known complication of deformity correction. Risk factors for early instrumentation failure are not well understood. High pre-op PI, PT and post-op SVA were risk factors associated with early failure. Abstract: Background: Early instrumentation failure (EIF) after pedicle subtraction osteotomy (PSO) is a known complication of adult spine deformity (ASD) correction. In contrast to the more common failure that occurs secondary to pseudarthrosis, early instrumentation failure (<6 months after surgery) and its risk factors are not as well understood. Objective: To identify risk factors for EIF in patients undergoing PSO for ASD correction. Methods: Patients with ASD who underwent correction with PSO from 2013 to 2018 were retrospectively reviewed. Demographic characteristics, number of rods, spinopelvic parameters, bone density derived from computed tomography (CT) attenuation in Hounsfield units (HU), Global Alignment and Proportion (GAP) score, and type of instrumentation failure were evaluated. Potential risk factors for EIF were analyzed. Results: 9 out of 46 (19.5%) patients who underwent PSO had EIF. All 9 patients with EIF had 2-rod constructs and failed secondary to rod fracture. The number of rods used in the EIF group was significantly lower than the non-EIF group (2.00 ± 0.00 vs 2.81 ± 0.995, p = .000. The EIF group demonstrated a significantly higher pre-op PI (77.33 ± 13.23), p = .022, pre-op PT (37.22 ± 6.46), p = .012, and post-op SVA (89.96 ± 23.85), p = .028 compared to the non-EIF group. Conclusion: High pre-op PI, pre-op PT, and post-op SVA were significant risk factors associated with EIF after PSO. Use of multiple rod constructs are protective and may help mitigate risk of EIF in these patients.