Kickstand Rod With Asymmetric Pedicle Subtraction Osteotomy for Treatment of Adult Kyphoscoliosis With Severe Coronal Imbalance. Issue 6 (5th June 2022)

• Record Type: Journal Article
• Authors: Safaee, Michael M.; Maloney, Patrick R.; Deviren, Vedat; Ames, Christopher P.
• Is Part Of: Operative neurosurgery. Volume 22:Issue 6(2022)
• Page Start: e245
• Page End: e250
• Publication Date: 2022-06-05
• Subjects: Coronal imbalance -- Kickstand rod -- Pedicle subtraction osteotomy; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1227/ons.0000000000000148
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract : BACKGROUND: The kickstand rod has been described for the treatment of severe coronal imbalance. We present a modified description that combines an asymmetric pedicle subtraction osteotomy (PSO) for correction of severe kyphoscoliosis. OBJECTIVE: To describe the use of a temporary kickstand rod. METHODS: Type 1 osteotomies were performed across the main and fractional curves. An asymmetric PSO was performed at the apex of the main curve, and a kickstand rod placed on the concavity anchored from the ilium to a temporary connector above the main curve. Distraction was applied across the kickstand rod because the PSO was closed on the convexity. A permanent rod was placed contralateral to the kickstand, followed by replacement of the kickstand with a permanent rod and bilateral accessory rods. RESULTS: A 66-year-old man presented with kyphoscoliosis causing severe coronal and sagittal imbalance. He underwent L4-S1 anterior lumbar interbody fusion followed by T4-pelvis instrumented fusion the following day. Type 1 osteotomies were performed from T6-T12 to L3-S1 and an asymmetric PSO at L2. A temporary kickstand rod was used to distract across the concavity because the PSO was closed on the convexity. The patient achieved excellent clinical and radiographical results. CONCLUSION: When used in conjunction with appropriate osteotomies, the kickstand rod can aid in correction of severe coronal imbalance. Use of a temporary kickstand rod is technically easier and allows for correction of the main and fractional curves when used with an asymmetric PSO.