Abstract
ABSTRACT Objective To identify the incidence and possible risk factors associated with rod breakage in patients who underwent vertebral column resection (VCR) or pedicle subtraction osteotomy (PSO) to treat complex deformities of the spine. Methods Retrospective analysis of a series of 32 patients operated from 2014 to 2018 in a single center. The patients were analyzed for demographic (sex, age), biometric (BMI), radiographical (pre- and postoperative angular variations), and surgical (arthrodesed and osteotomized levels) characteristics. Descriptive analyses were performed for the numerical variables (mean, standard deviation, maximum, median, and minimum) and frequency analysis was performed for the categorical variables. Logistic regression analysis was performed for the dependent variable “rod breakage”, using a stepwise technique to select the variables for the best model, assuming statistical significance of 0.05. Results Of the 32 patients selected, rod breakage occurred in 34.4%. Mean age was 36.6 years (± 19.8), ranging from 10 to 74 years, and the mean BMI was 25.1 (±6.0). Most patients were subjected to VCR (75.0%), were males (56.2%) and did not smoke (90.6%). Logistic regression analysis showed that “arthrodesed levels” were was positively associated with rod breakage (OR 1.72; CI95%: 1.13-3.10; p<0.05). The other factors were not associated with breakage. Conclusion Rod breakage is a frequent complication after three-column osteotomy, especially in long constructions. Level of evidence III; Retrospective Study.
Highlights
Major improvements in surgical techniques, the development of new instrumentation materials, and multimodal neuromonitorization have made procedures like pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) increasingly common in the treatment of complex and rigid spinal deformities. Both PSO and VCR are called three-column osteotomies (3CO) because they extend from the posterior to the anterior spine.[1]
All the patients were submitted to 3CO (PSO or VCR), most of them with initial instrumentation with two 5.5 mm titanium rods, performed by the same surgical team
We found that the model with “arthrodesed levels” and “tobacco use” presented the lowest AIC (Akaike information criterion), without statistical significance of the odds ratios
Summary
Major improvements in surgical techniques, the development of new instrumentation materials, and multimodal neuromonitorization have made procedures like pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR) increasingly common in the treatment of complex and rigid spinal deformities. Both PSO and VCR are called three-column osteotomies (3CO) because they extend from the posterior to the anterior spine.[1]. These techniques are valuable tools in the treatment of severe deformities. The literature reports high rates of complications, such as neurological injuries, fractures at adjacent levels, consolidation defects, and instrumentation failure.[3,4,5]
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