Hassan Fthimnir M, Bautista Anson, Reyes Justin L, Puvanesarajah Varun, Coury Josephine R, Mohanty Sarthak, Lombardi Joseph M, Sardar Zeeshan M, Lehman Ronald A, Lenke Lawrence G
Department of Orthopaedic Surgery, The Och Spine Hospital/Columbia University Irving Medical Center, New York, NY, USA.
Department of Orthopaedic Surgery, Dwight D. Eisenhower VA Medical Center, Leavenworth, KS, USA.
Spine Deform. 2025 Jan;13(1):273-285. doi: 10.1007/s43390-024-00950-8. Epub 2024 Aug 20.
To assess and compare coronal alignment correction at 2 year follow-up in adult spinal deformity (ASD) patients treated with and without the kickstand rod (KSR) construct.
ASD patients who underwent posterior spinal fusion at a single-center with a preoperative coronal vertical axis (CVA) ≥ 3 cm and a minimum of 2 year clinical and radiographic follow-up were identified. Patients were divided into two groups: those treated with a KSR and those who were not. Patients were propensity score-matched (PSM) controlling for preoperative CVA and instrumented levels to limit potential biases that my influence the magnitude of coronal correction.
One hundred sixteen patients were identified (KSR = 42, Control = 74). There were no statistically significant differences in patient characteristics (p > 0.05). At baseline, the control group presented with a greater LS curve (29.0 ± 19.6 vs. 21.5 ± 10.8, p = 0.0191) while the KSR group presented with a greater CVA (6.3 ± 3.6 vs. 4.5 ± 1.8, p = 0.0036). After 40 PSM pairs were generated, there were no statistically significant differences in baseline patient and radiographic characteristics. Within the matched cohorts, the KSR group demonstrated greater CVA correction at 1 year (4.7 ± 2.4 cm vs. 2.9 ± 2.2 cm, p = 0.0012) and 2 year follow-up (4.7 ± 2.6 cm vs. 3.1 ± 2.6 cm, p = 0.0020) resulting in less coronal malalignment one (1.5 ± 1.3 cm vs. 2.4 ± 1.6 cm, p = 0.0056) and 2 year follow-up (1.6 ± 1.0 vs. 2.5 ± 1.5 cm, p = 0.0110). No statistically significant differences in PROMs, asymptomatic mechanical complications, reoperations for non-mechanical complications were observed at 2 year follow-up. However, the KSR group experienced a lesser rate of mechanical complications requiring reoperations (7.1% vs. 24.3%. OR = 0.15 [0.03-0.72], p = 0.0174).
Patients treated with a KSR had a greater amount of coronal realignment at the 2 year follow-up time period and reported less mechanical complications requiring reoperation. However, 2 year patient-reported outcomes were similar between the two groups.
评估和比较在成人脊柱畸形（ASD）患者中，使用和不使用支架棒（KSR）结构进行治疗后2年随访时的冠状面排列矫正情况。
确定在单中心接受后路脊柱融合术、术前冠状面垂直轴（CVA）≥3 cm且至少有2年临床和影像学随访的ASD患者。患者分为两组：接受KSR治疗的患者和未接受KSR治疗的患者。对患者进行倾向评分匹配（PSM），以控制术前CVA和固定节段，以限制可能影响冠状面矫正幅度的潜在偏差。
共确定116例患者（KSR组=42例，对照组=74例）。患者特征方面无统计学显著差异（p>0.05）。基线时，对照组的腰椎曲线更大（29.0±19.6 vs. 21.5±10.8，p=0.0191），而KSR组的CVA更大（6.3±3.6 vs. 4.5±1.8，p=0.0036）。生成40对PSM后，基线患者和影像学特征无统计学显著差异。在匹配队列中，KSR组在1年（4.7±2.4 cm vs. 2.9±2.2 cm，p=0.0012）和2年随访时（4.7±2.6 cm vs. 3.1±2.6 cm，p=0.0020）显示出更大的CVA矫正，导致1年（1.5±1.3 cm vs. 2.4±1.6 cm，p=0.0056）和2年随访时（1.6±1.0 vs. 2.5±1.5 cm，p=0.0110）的冠状面排列不齐更少。在2年随访时，患者报告结局量表（PROMs）、无症状机械并发症、非机械并发症再次手术方面无统计学显著差异。然而，KSR组因机械并发症需要再次手术的发生率较低（7.1% vs. 24.3%。OR=0.15[0.03-0.72]，p=0.0174）。
在2年随访期内，接受KSR治疗的患者冠状面重新排列程度更大，且因机械并发症需要再次手术的情况较少。然而，两组患者2年的患者报告结局相似。
