Park Se-Jun, Park Jin-Sung, Lee Chong-Suh, Kang Dong-Ho
Department of Orthopedic Surgery, Samsung Medical Center, Seoul 06351, Republic of Korea.
Department of Orthopedic Surgery, Haeundae Bumin Hospital, Busan 48094, Republic of Korea.
J Clin Med. 2025 Aug 9;14(16):5643. doi: 10.3390/jcm14165643.
: Given the different biomechanical properties and surgical techniques between the L5-S1 and ≥L4-5 levels, it is necessary to explore RF risk factors at ≥L4-5 levels separately from the lumbosacral junction. This study aims to investigate the risk factors for rod fracture (RF) occurring at ≥L4-5 levels following adult spinal deformity (ASD) surgery. RF occurrence was assessed at the segment level. : Patients who underwent ≥ 5-level fusion, including the sacrum or pelvis, with a minimum follow-up of 2 years were included in this study. Presumed risk factors in terms of patient, surgical, and radiographic variables were compared between the non-RF and RF groups at the segment level. Multivariate logistic regression analysis was performed to identify independent risk factors for RF at ≥L4-5 levels. : A total of 318 patients (mean age, 69.3 years; 88.4% female) were included, and 1082 segments were evaluated. During the mean follow-up duration of 47.4 months, RF developed in 45 (14.2%) patients for 51 (4.7%) segments. In multivariate logistic regression analysis, several risk factors were identified, as follows: the use of perioperative teriparatide (odds ratio [OR] = 0.26, = 0.012), operated levels (L2-3 and L3-4 vs. L4-5 level [OR = 0.45, = 0.022; OR = 0.16, < 0.001, respectively]), fusion methods (posterior fusion and anterior column realignment vs. posterior lumbar interbody fusion [OR = 8.04, < 0.001; OR = 5.37, = 0.002, respectively]), pedicle subtraction osteotomy (PSO) (OR = 3.14, = 0.020), and number of rods (four-rod configuration vs. dual-rod fixation [OR = 0.34, = 0.044]). : In this study, the factors related to RF at ≥L4-5 levels included the perioperative use of teriparatide, operated levels, fusion methods, performance of PSO, and rod configuration. Considering that surgical procedures vary by each segment, our findings may help establish segment-specific preventive strategies to reduce RF at ≥L4-5 levels.
鉴于L5-S1和≥L4-5节段之间存在不同的生物力学特性和手术技术，有必要将≥L4-5节段的内固定棒断裂（RF）危险因素与腰骶交界处分开进行探讨。本研究旨在调查成人脊柱畸形（ASD）手术后≥L4-5节段发生内固定棒断裂（RF）的危险因素。在内固定棒断裂（RF）的发生情况评估在节段层面进行。纳入接受包括骶骨或骨盆在内的≥5节段融合且最短随访2年的患者。在节段层面比较非内固定棒断裂（RF）组和内固定棒断裂（RF）组在患者、手术和影像学变量方面的假定危险因素。进行多因素逻辑回归分析以确定≥L4-5节段内固定棒断裂（RF）的独立危险因素。共纳入318例患者（平均年龄69.3岁；88.4%为女性），评估了1082个节段。在平均47.4个月的随访期间，45例（14.2%）患者的51个（4.7%）节段发生了内固定棒断裂（RF）。在多因素逻辑回归分析中，确定了几个危险因素，如下：围手术期使用特立帕肽（比值比[OR]=0.26，P=0.012）、手术节段（L2-3和L3-4与L4-5节段相比[OR分别为0.45，P=0.022；OR=0.16，P<0.001]）、融合方法（后路融合和前路柱重建与腰椎后路椎间融合相比[OR分别为8.04，P<0.001；OR=5.37，P=0.002]）、椎弓根截骨术（PSO）（OR=3.14，P=0.020）以及棒的数量（四棒结构与双棒固定相比[OR=0.34，P=0.044]）。在本研究中，与≥L4-5节段内固定棒断裂（RF）相关的因素包括围手术期使用特立帕肽、手术节段、融合方法、椎弓根截骨术（PSO）的实施以及棒的结构。考虑到每个节段的手术操作不同，我们的研究结果可能有助于制定节段特异性预防策略以减少≥L4-5节段的内固定棒断裂（RF）。
