Konuma Hiroki, Katayanagi Junya, Iida Takahiro, Morishita Shingo, Tanaka Tomoyuki, Yanase Tsukasa, Jinno Tetsuya, Inose Hiroyuki
Department of Orthopedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minami-Koshigaya, Koshigaya-shi, Saitama, 343-8555, Japan.
Department of Orthopedic Surgery, Teine Keijinkai Hospital, Sapporo, Japan.
Spine Deform. 2025 Mar;13(2):481-487. doi: 10.1007/s43390-024-00985-x. Epub 2024 Oct 14.
Adult spinal deformity (ASD) has a significant impact on trunk balance and quality of life in the elderly. Postoperative rod fractures pose significant challenges, but the mechanisms of their occurrence are underexplored compared to other complications such as proximal junctional kyphosis. This study investigated factors associated with rod fracture in patients with ASD.
A retrospective single-center study analyzed 110 adult patients who underwent spinal deformity correction between 2012 and 2020. Comparative analysis and univariate and multivariate Cox regression analyses were employed to identify factors associated with rod fracture.
In this study, rod fracture occurred in 14.5% of patients. The rod fracture group exhibited a larger change in lumbar lordosis (LL), a higher proportion of patients with pre-operatively existing (pre-existing) vertebral fractures, and a greater percentage of patients with a rod diameter of 6 mm or less compared to the non-rod fracture group. Univariate Cox regression analysis revealed that rod fracture was associated with pre-existing vertebral fracture, LL change, preoperative sagittal vertical axis, and preoperative pelvic tilt. Multivariate Cox regression analysis identified pre-existing vertebral fractures and the amount of LL change as independent factors associated with rod fractures.
Pre-existing vertebral fractures and the magnitude of lumbar lordosis correction are independent risk factors for rod fracture following ASD surgery. Surgeons should consider these factors during preoperative planning to reduce the risk of postoperative rod fracture.
IV.
成人脊柱畸形（ASD）对老年人的躯干平衡和生活质量有重大影响。术后棒材骨折带来了重大挑战，但与近端交界性后凸等其他并发症相比，其发生机制的研究较少。本研究调查了ASD患者中与棒材骨折相关的因素。
一项回顾性单中心研究分析了2012年至2020年间接受脊柱畸形矫正的110例成年患者。采用比较分析以及单变量和多变量Cox回归分析来确定与棒材骨折相关的因素。
在本研究中，14.5%的患者发生了棒材骨折。与非棒材骨折组相比，棒材骨折组的腰椎前凸（LL）变化更大，术前存在（既往存在）椎体骨折的患者比例更高，棒材直径为6毫米或更小的患者百分比更高。单变量Cox回归分析显示，棒材骨折与既往椎体骨折、LL变化、术前矢状垂直轴和术前骨盆倾斜有关。多变量Cox回归分析确定既往椎体骨折和LL变化量是与棒材骨折相关的独立因素。
既往椎体骨折和腰椎前凸矫正幅度是ASD手术后棒材骨折的独立危险因素。外科医生在术前规划时应考虑这些因素，以降低术后棒材骨折的风险。
IV级。
