The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion

D. Kojo Hamilton, John A. Buza, Peter Passias, Cyrus Jalai, Han Jo Kim, Tamir Ailon, Munish Gupta, Daniel Sciubba, Amit Jain, Christopher P. Ames, Vedat Deviren, Alan Daniels, Virginie Lafage, Shay Bess, Eric Klineberg, Christopher I. Shaffrey, Justin S. Smith, Robert Hart

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion. Methods: Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included. Health-related quality of life scores and radiographic alignment were compared with nonparametric paired and independent testing (P < 0.05). Results: A total of 51 of 343 patients with ASD (14.9%) sustained a RF, of whom 44 (86.3%) had at least 6-month follow up after RF (mean age = 61.2 years, mean body mass index = 29.6 kg/m2). Mean total follow-up was 37.8 months (range 24.5-66.7 months). Interbody fusion was used in 26 cases of RF (59.1%) (transforaminal lumbar interbody fusion, n = 17 [65.4%], anterior lumbar interbody fusion, n = 5 [19.2%]). RF was symptomatic in 26 of 44 (59.1%) of patients and discovered incidentally in 18 of 44 patients (40.9%). Overall, 28 RFs were revised (63.6%); 12 of 23 (52.2%) unilateral RF and 16 of 21 (76.2%) bilateral RF at last follow-up. Revision patients were significantly more likely to be symptomatic at the time of RF detection (78.6% vs. 25.0%, P = 0.0006), and had significantly worse Oswestry Disability Index and Scoliosis Research Society-22r pain scores. Conclusions: RFs were detected in 14.9% of patients with ASD and were most common at the L4-L5 and L5-S1 levels. Approximately 63.6% of patients underwent revision surgery. The decision to perform revision surgery may be based predominantly on symptoms referable to the RF, pain, and perceived disability, as radiographic parameters at the time of RF did not differ significantly between patients who did and did not undergo revision.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - 2017

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Reoperation
Pain
Scoliosis
Body Mass Index
Quality of Life
Databases
Research

Keywords

  • Adult spinal deformity
  • Health-related quality of life
  • Oswestry Disability Index
  • Pedicle subtraction osteotomy
  • Revision
  • Rod fracture

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Hamilton, D. K., Buza, J. A., Passias, P., Jalai, C., Kim, H. J., Ailon, T., ... Hart, R. (Accepted/In press). The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion. World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.07.061

The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion. / Hamilton, D. Kojo; Buza, John A.; Passias, Peter; Jalai, Cyrus; Kim, Han Jo; Ailon, Tamir; Gupta, Munish; Sciubba, Daniel; Jain, Amit; Ames, Christopher P.; Deviren, Vedat; Daniels, Alan; Lafage, Virginie; Bess, Shay; Klineberg, Eric; Shaffrey, Christopher I.; Smith, Justin S.; Hart, Robert.

In: World Neurosurgery, 2017.

Research output: Contribution to journalArticle

Hamilton, DK, Buza, JA, Passias, P, Jalai, C, Kim, HJ, Ailon, T, Gupta, M, Sciubba, D, Jain, A, Ames, CP, Deviren, V, Daniels, A, Lafage, V, Bess, S, Klineberg, E, Shaffrey, CI, Smith, JS & Hart, R 2017, 'The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion', World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.07.061
Hamilton, D. Kojo ; Buza, John A. ; Passias, Peter ; Jalai, Cyrus ; Kim, Han Jo ; Ailon, Tamir ; Gupta, Munish ; Sciubba, Daniel ; Jain, Amit ; Ames, Christopher P. ; Deviren, Vedat ; Daniels, Alan ; Lafage, Virginie ; Bess, Shay ; Klineberg, Eric ; Shaffrey, Christopher I. ; Smith, Justin S. ; Hart, Robert. / The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion. In: World Neurosurgery. 2017.
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title = "The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion",
abstract = "Objective: To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion. Methods: Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included. Health-related quality of life scores and radiographic alignment were compared with nonparametric paired and independent testing (P < 0.05). Results: A total of 51 of 343 patients with ASD (14.9{\%}) sustained a RF, of whom 44 (86.3{\%}) had at least 6-month follow up after RF (mean age = 61.2 years, mean body mass index = 29.6 kg/m2). Mean total follow-up was 37.8 months (range 24.5-66.7 months). Interbody fusion was used in 26 cases of RF (59.1{\%}) (transforaminal lumbar interbody fusion, n = 17 [65.4{\%}], anterior lumbar interbody fusion, n = 5 [19.2{\%}]). RF was symptomatic in 26 of 44 (59.1{\%}) of patients and discovered incidentally in 18 of 44 patients (40.9{\%}). Overall, 28 RFs were revised (63.6{\%}); 12 of 23 (52.2{\%}) unilateral RF and 16 of 21 (76.2{\%}) bilateral RF at last follow-up. Revision patients were significantly more likely to be symptomatic at the time of RF detection (78.6{\%} vs. 25.0{\%}, P = 0.0006), and had significantly worse Oswestry Disability Index and Scoliosis Research Society-22r pain scores. Conclusions: RFs were detected in 14.9{\%} of patients with ASD and were most common at the L4-L5 and L5-S1 levels. Approximately 63.6{\%} of patients underwent revision surgery. The decision to perform revision surgery may be based predominantly on symptoms referable to the RF, pain, and perceived disability, as radiographic parameters at the time of RF did not differ significantly between patients who did and did not undergo revision.",
keywords = "Adult spinal deformity, Health-related quality of life, Oswestry Disability Index, Pedicle subtraction osteotomy, Revision, Rod fracture",
author = "Hamilton, {D. Kojo} and Buza, {John A.} and Peter Passias and Cyrus Jalai and Kim, {Han Jo} and Tamir Ailon and Munish Gupta and Daniel Sciubba and Amit Jain and Ames, {Christopher P.} and Vedat Deviren and Alan Daniels and Virginie Lafage and Shay Bess and Eric Klineberg and Shaffrey, {Christopher I.} and Smith, {Justin S.} and Robert Hart",
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T1 - The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion

AU - Hamilton, D. Kojo

AU - Buza, John A.

AU - Passias, Peter

AU - Jalai, Cyrus

AU - Kim, Han Jo

AU - Ailon, Tamir

AU - Gupta, Munish

AU - Sciubba, Daniel

AU - Jain, Amit

AU - Ames, Christopher P.

AU - Deviren, Vedat

AU - Daniels, Alan

AU - Lafage, Virginie

AU - Bess, Shay

AU - Klineberg, Eric

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

AU - Hart, Robert

PY - 2017

Y1 - 2017

N2 - Objective: To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion. Methods: Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included. Health-related quality of life scores and radiographic alignment were compared with nonparametric paired and independent testing (P < 0.05). Results: A total of 51 of 343 patients with ASD (14.9%) sustained a RF, of whom 44 (86.3%) had at least 6-month follow up after RF (mean age = 61.2 years, mean body mass index = 29.6 kg/m2). Mean total follow-up was 37.8 months (range 24.5-66.7 months). Interbody fusion was used in 26 cases of RF (59.1%) (transforaminal lumbar interbody fusion, n = 17 [65.4%], anterior lumbar interbody fusion, n = 5 [19.2%]). RF was symptomatic in 26 of 44 (59.1%) of patients and discovered incidentally in 18 of 44 patients (40.9%). Overall, 28 RFs were revised (63.6%); 12 of 23 (52.2%) unilateral RF and 16 of 21 (76.2%) bilateral RF at last follow-up. Revision patients were significantly more likely to be symptomatic at the time of RF detection (78.6% vs. 25.0%, P = 0.0006), and had significantly worse Oswestry Disability Index and Scoliosis Research Society-22r pain scores. Conclusions: RFs were detected in 14.9% of patients with ASD and were most common at the L4-L5 and L5-S1 levels. Approximately 63.6% of patients underwent revision surgery. The decision to perform revision surgery may be based predominantly on symptoms referable to the RF, pain, and perceived disability, as radiographic parameters at the time of RF did not differ significantly between patients who did and did not undergo revision.

AB - Objective: To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion. Methods: Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included. Health-related quality of life scores and radiographic alignment were compared with nonparametric paired and independent testing (P < 0.05). Results: A total of 51 of 343 patients with ASD (14.9%) sustained a RF, of whom 44 (86.3%) had at least 6-month follow up after RF (mean age = 61.2 years, mean body mass index = 29.6 kg/m2). Mean total follow-up was 37.8 months (range 24.5-66.7 months). Interbody fusion was used in 26 cases of RF (59.1%) (transforaminal lumbar interbody fusion, n = 17 [65.4%], anterior lumbar interbody fusion, n = 5 [19.2%]). RF was symptomatic in 26 of 44 (59.1%) of patients and discovered incidentally in 18 of 44 patients (40.9%). Overall, 28 RFs were revised (63.6%); 12 of 23 (52.2%) unilateral RF and 16 of 21 (76.2%) bilateral RF at last follow-up. Revision patients were significantly more likely to be symptomatic at the time of RF detection (78.6% vs. 25.0%, P = 0.0006), and had significantly worse Oswestry Disability Index and Scoliosis Research Society-22r pain scores. Conclusions: RFs were detected in 14.9% of patients with ASD and were most common at the L4-L5 and L5-S1 levels. Approximately 63.6% of patients underwent revision surgery. The decision to perform revision surgery may be based predominantly on symptoms referable to the RF, pain, and perceived disability, as radiographic parameters at the time of RF did not differ significantly between patients who did and did not undergo revision.

KW - Adult spinal deformity

KW - Health-related quality of life

KW - Oswestry Disability Index

KW - Pedicle subtraction osteotomy

KW - Revision

KW - Rod fracture

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