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PMID- 28894680
OWN - NLM
STAT- PubMed-not-MEDLINE
DA  - 20170912
LR  - 20170914
IS  - 2192-5682 (Print)
IS  - 2192-5682 (Linking)
VI  - 7
IP  - 6
DP  - 2017 Sep
TI  - Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the
      Lumbosacral Junction in Adult Spinal Deformity.
PG  - 514-520
LID - 10.1177/2192568217699392 [doi]
AB  - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine if patients
      fused with multi-rod constructs to the pelvis have a lower incidence of
      lumbosacral rod failure and pseudarthrosis than those fused with dual-rod
      constructs. METHODS: We performed a retrospective review of consecutive adult
      spinal deformity patients who underwent long fusion to the pelvis. Inclusion
      criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and
      minimum 1-year follow-up. Revision patients with indications other than L5-S1
      pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed 
      for rod integrity, and computed tomography scan (CT) was obtained whenever rod
      breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were
      statistically compared. RESULTS: There were 31 patients with 15 in the dual-rod
      group and 16 in the multi-rod group, with average ages of 68 +/- 9 and 63 +/- 12 
      years, respectively. No patients in the multi-rod group experienced rod fracture,
      whereas 6 in the dual-rod group fractured a rod (P = .007), with 4 occurring at
      the lumbosacral junction (P = .04). CT scan in the 4 lumbosacral rod fracture
      cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic
      nonunion at the L5-S1 junction. CONCLUSION: Patients with dual-rod constructs had
      a statistically greater incidence of lumbosacral pseudarthrosis with implant
      failure than those with multi-rod constructs. CT and surgical exploration showed 
      hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests
      that mechanical instability, not biology, is the main reason for failure, and
      could be addressed with the use of multi-rods.
FAU - Merrill, Robert K
AU  - Merrill RK
AD  - Icahn School of Medicine at Mount Sinai, New York, NY, USA.
FAU - Kim, Jun S
AU  - Kim JS
AD  - Icahn School of Medicine at Mount Sinai, New York, NY, USA.
FAU - Leven, Dante M
AU  - Leven DM
AD  - Icahn School of Medicine at Mount Sinai, New York, NY, USA.
FAU - Kim, Joung Heon
AU  - Kim JH
AD  - Icahn School of Medicine at Mount Sinai, New York, NY, USA.
FAU - Cho, Samuel K
AU  - Cho SK
AD  - Icahn School of Medicine at Mount Sinai, New York, NY, USA.
LA  - eng
PT  - Journal Article
DEP - 20170411
PL  - England
TA  - Global Spine J
JT  - Global spine journal
JID - 101596156
PMC - PMC5582710
OTO - NOTNLM
OT  - hypertrophic nonunion
OT  - lumbosacral junction
OT  - multi-rod fusion
OT  - pelvic fixation
OT  - pseudarthrosis
OT  - rod fracture
COI - Declaration of Conflicting Interests: The author(s) declared no potential
      conflicts of interest with respect to the research, authorship, and/or
      publication of this article.
EDAT- 2017/09/13 06:00
MHDA- 2017/09/13 06:01
CRDT- 2017/09/13 06:00
AID - 10.1177/2192568217699392 [doi]
AID - 10.1177_2192568217699392 [pii]
PST - ppublish
SO  - Global Spine J. 2017 Sep;7(6):514-520. doi: 10.1177/2192568217699392. Epub 2017
      Apr 11.