Fiani Brian, Jarrah Ryan M
Neurosurgery, Desert Regional Medical Center, Palm Springs, USA.
Neurosurgery, Mayo Clinic, Rochester, USA.
Cureus. 2020 Dec 3;12(12):e11876. doi: 10.7759/cureus.11876.
Coronal imbalance is a type of spinal deformity with deviation from midline in the coronal plane. It is challenging to correct even in the hands of experienced spine surgeons. Many conventional techniques lead to unsuccessful results or complications. However, the incorporation of "kickstand rod" (KR) instrumentation is now understood to provide a more supported coronal correction and improve spinal deformities. Sometimes it can be used to provide additional spinal support in instances where spinal fusion has already occurred. The KR is placed from a posterior approach along the lateral spine from lumbar spine to ilium and exerts distraction forces that counteract misaligned spinal segments. Our objective is to present a clinical case example with a brief review of literature. Herein, we present a case of a 62-year-old male with the development of significant coronal imbalance following his posterior lumbosacral instrumentation and fusion 11 years prior to presentation. KR supplementation to his hardware improved his functional outcome significantly. Further, we provide a literature review of the surgical characteristics, indications, and functional outcomes of KR instrumentation. A term search of "kickstand rod" was performed in PubMed, and relevant English language publications were included. The literature search yielded only six publications. A total of 45 patients across three studies were assessed. A mean postoperative coronal balance magnitude of 26.83 mm was calculated compared to the preoperative coronal magnitude of 64.16 mm. Results also showed only four cases of intraoperative or postoperative complications. Moreover, the presented case reported successful KR implementation without any intraoperative complications. KR instrumentation is a safe and effective technique for coronal imbalance correction. The results show favorable outcomes in terms of coronal adjustment and low complication rates. Nevertheless, we caution the fact that further studies are warranted with long-term follow-ups.
冠状面失衡是一种脊柱畸形，在冠状面上偏离中线。即使在经验丰富的脊柱外科医生手中，纠正起来也具有挑战性。许多传统技术会导致手术结果不理想或出现并发症。然而，现在人们认识到采用“支架棒”（KR）器械可以提供更有力的冠状面矫正，并改善脊柱畸形。有时，在脊柱已经融合的情况下，它可用于提供额外的脊柱支撑。KR通过后路沿着脊柱外侧从腰椎放置到髂骨，施加牵张力以抵消脊柱节段的排列不齐。我们的目的是通过简要回顾文献来呈现一个临床病例。在此，我们报告一例62岁男性病例，该患者在就诊前11年接受腰骶部后路器械固定和融合手术后出现了明显的冠状面失衡。对其硬件补充KR显著改善了他的功能结局。此外，我们对KR器械的手术特点、适应证和功能结局进行了文献综述。在PubMed上对“支架棒”进行了术语搜索，并纳入了相关的英文出版物。文献搜索仅得到六篇出版物。三项研究共评估了45例患者。计算得出术后冠状面平衡平均幅度为26.83毫米，而术前冠状面幅度为64.16毫米。结果还显示仅4例术中或术后并发症。此外，所报告的病例显示KR植入成功，无任何术中并发症。KR器械是一种安全有效的纠正冠状面失衡的技术。结果显示在冠状面调整方面效果良好，并发症发生率低。尽管如此，我们提醒需要进行进一步的长期随访研究。
