Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Spine Center of Excellence, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Orthopedic Surgery, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
World Neurosurg. 2024 Mar;183:e530-e539. doi: 10.1016/j.wneu.2023.12.137. Epub 2023 Dec 29.
In this retrospective study we compared clinicoradiologic outcomes and complication profiles of the traditional 2-rod construct versus the 4-rod construct in patients with adult spinal deformity (ASD) who underwent pedicle subtraction osteotomy (PSO).
We performed a retrospective review of 208 ASD patients at 2 referral centers who underwent lumbar PSO and long fusion from thoracic to the pelvis. Two different techniques, including the 4-rod construct and the traditional 2-rod technique, were used at the PSO level. Clinicoradiologic outcomes and complication profiles of the patients were documented and compared statistically between the groups.
The 4-rod construct was associated with statistically lower rates of rod fracture (44.8% vs. 26.4%, P < 0.01), pedicular screw loosening at the PSO level (25.3% vs. 14.0%, P = 0.04), and reoperation (49.4% vs. 33.9%, P = 0.02). Radiologically, the 4-rod construct was associated with higher degree of lumbar lordosis (LL) (-37.4°vs. -26.8°; P < 0.01) and improved pelvic tilt (PT) (-17.2° vs. -9.9°; P < 0.01) and sacral vertical axis (SVA) corrections (-211.5° vs. -192.2°; P = 0.04). Overall, the 4-rod construct was associated with improved quality of life (P = 0.04) and statistically lower Oswestry Disability Index score at 12 months postoperatively (P < 0.01).
Our results showed that the 4-rod construct was associated with statistically lower rates of rod fracture and pedicular screw loosening at the osteotomy level, higher degree of LL correction and improved PT and SVA than the 2-rod technique. The 4-rod construct was also associated with improved quality of life and Oswestry Disability Index and lower complication profiles.
本回顾性研究比较了经椎弓根截骨术（PSO）治疗成人脊柱畸形（ASD）患者中传统的 2 棒结构与 4 棒结构的临床影像学结果和并发症特征。
我们对 2 个转诊中心的 208 例 ASD 患者进行了回顾性分析，这些患者均接受了腰椎 PSO 和从胸到骨盆的长节段融合。在 PSO 水平使用了两种不同的技术，包括 4 棒结构和传统的 2 棒技术。记录了患者的临床影像学结果和并发症特征，并对两组进行了统计学比较。
4 棒结构与较低的棒断裂率（44.8% vs. 26.4%，P < 0.01）、PSO 水平的椎弓根螺钉松动率（25.3% vs. 14.0%，P = 0.04）和再手术率（49.4% vs. 33.9%，P = 0.02）相关。影像学上，4 棒结构与更大的腰椎前凸角（LL）（-37.4°vs. -26.8°；P < 0.01）和更好的骨盆倾斜角（PT）（-17.2° vs. -9.9°；P < 0.01）和骶骨垂直轴（SVA）矫正（-211.5° vs. -192.2°；P = 0.04）相关。总的来说，4 棒结构与改善的生活质量（P = 0.04）和术后 12 个月时统计学上较低的 Oswestry 功能障碍指数评分（P < 0.01）相关。
我们的结果表明，与 2 棒技术相比，4 棒结构与较低的棒断裂和 PSO 水平的椎弓根螺钉松动率、更大的 LL 矫正角度和更好的 PT 和 SVA 相关。4 棒结构还与改善的生活质量、Oswestry 功能障碍指数评分和较低的并发症发生率相关。
