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Bayatli E, Dogan I, Özgüral O, Kuzukiran YC, Demiryurek S, Mete EB, Ozalp Ates FS, Zaimoğlu M, Eroglu U, Kahilogulları G, Ugur HC, Attar A, Caglar YS. Does the Extent of Rod Bending and Actual Lumbar Lordosis Mismatch Affect Quality of Life? World Neurosurg 2024; 182:e57-e61. [PMID: 37979686 DOI: 10.1016/j.wneu.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND To evaluate any mismatch between rod bending and actual lordosis during posterior lumbar instrumentation and its effects on the quality of life (QOL) of patients. METHODS Patient records for posterior lumbar fusion in 2018-2023 were retrospectively reviewed. The radiologic parameters consisted of pelvic incidence, sacral slope, L1S1 lumbar lordosis, lumbosacral angle, the distance between the posterior wall of the vertebra and the rod, lordosis of the rod. The postoperative QOL of patients was assessed using Oswestry Disability Index. The patients were grouped postoperative into Group-1 (minimal/moderate disability) and Group-2 (severe disability/crippled/bed bound). RESULTS Total of 133 patients were included; 99 women, 34 men. The difference was significant for patients with diabetes to be presented in the more disabled Group-2. The distance between the posterior vertebral wall and the rod was found to be short in Group-2. Preoperative and postoperative sagittal lumbar Cobb angles were significantly higher in Group-2. The changing degree of pain was found to score high in Group-2. The postoperative visual analog scale was high in Group-2. The difference between the preoperative and postoperative lumbar sagittal Cobb and rod Cobb-angles was found to be high in Group-2. CONCLUSIONS The results of our study confirm the importance of considering the preoperative actual lumbar lordosis during bending and maintaining it as much as possible. To our knowledge, this is the first study that evaluated the effect of rod bending on quality of life (QOL) and supports that this might be affected in case of any mismatches.
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Affiliation(s)
- Eyüp Bayatli
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Ihsan Dogan
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey.
| | - Onur Özgüral
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Yusuf Cem Kuzukiran
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Sevde Demiryurek
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Emre Bahir Mete
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Funda Seher Ozalp Ates
- Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | - Murat Zaimoğlu
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Gökmen Kahilogulları
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Hasan Caglar Ugur
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Ayhan Attar
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
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Boissiere L, Bourghli A, Guevara-Villazon F, Pellisé F, Alanay A, Kleinstück F, Pizones J, Roscop C, Larrieu D, Obeid I. Rod Angulation Relationship with Thoracic Kyphosis after Adolescent Idiopathic Scoliosis Posterior Instrumentation. CHILDREN (BASEL, SWITZERLAND) 2023; 11:29. [PMID: 38255344 PMCID: PMC10813855 DOI: 10.3390/children11010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Surgery to correct spinal deformities in scoliosis involves the use of contoured rods to reshape the spine and correct its curvatures. It is crucial to bend these rods appropriately to achieve the best possible correction. However, there is limited research on how the rod bending process relates to spinal shape in adolescent idiopathic scoliosis surgery. METHODS A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal. RESULTS This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery. CONCLUSIONS Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
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Affiliation(s)
- Louis Boissiere
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Anouar Bourghli
- Spine Surgery Department, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | | | - Ferran Pellisé
- Spine Surgery Unit, Hospital Universitario Val Hebron, 08035 Barcelona, Spain
| | - Ahmet Alanay
- Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Istanbul 34750, Turkey
| | - Frank Kleinstück
- Research and Development, Schulthess Klinik, 8008 Zurich, Switzerland
| | - Javier Pizones
- Spine Surgery Unit, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Cécile Roscop
- Spine Surgery Unit, CHU Pellegrin, 33076 Bordeaux, France
| | - Daniel Larrieu
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
| | - Ibrahim Obeid
- ELSAN, Polyclinique Jean Villar, 53 Avenue Maryse Bastié, 33520 Bruges, France
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Shi Z, Zhang C, Wang B, Nicolas YSM, Chen J, Yang G. Analysis of Influencing Factors of Vertebral Height Loss After Pedicle Screw Fixation of Thoracolumbar Fracture. Clin Spine Surg 2023; 36:E362-E368. [PMID: 37296489 PMCID: PMC10521793 DOI: 10.1097/bsd.0000000000001467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVE To explore the related factors of vertebral height loss (VHL) after pedicle screw fixation of thoracolumbar fracture and to determine the optimum prediction point. SUMMARY OF BACKGROUND DATA With the widespread application of thoracolumbar fracture internal fixation, VHL after the operation is increasingly presented. However, there is no unified conclusion on the specific cause of VHL and how to predict it. METHODS A total of 186 patients were selected and divided into the loss group (n = 72) and the not-loss group (n = 114) according to whether the fractured vertebral height was lost after the operation. The two groups were compared concerning sex, age, body mass index, osteoporosis self-assessment tool for Asians (OSTA), fracture types, number of fractured vertebrae, preoperative Cobb angle and compression degree, number of screws, and extent of vertebral restore. Univariate analysis and Multivariate logistic regression analysis were performed to identify the independent factors for the VHL with the receiver operating characteristic curve and the optimal prediction value was calculated according to area under the curve. RESULTS Multivariate logistic regression analysis showed that OSTA ( P < 0.05) and preoperative vertebral compression ( P < 0.05) were significantly correlated with postoperative VHL, which were independent risk factors for postoperative VHL. The OSTA of 2.32 and the preoperative vertebral compression degree of 38.5% were the best prediction points for postoperative VHL based on the Youden Index analysis. CONCLUSIONS The OSTA and preoperative vertebral compression were independent risk factors for VHL. The risk of postoperative VHL was significantly higher when the OSTA was ≤2.32 or the preoperative vertebral compression was ≥38.5%. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zongpo Shi
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University
| | - Chen Zhang
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University
| | - Boyao Wang
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yap San Min Nicolas
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ji Chen
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University
| | - Gaungxu Yang
- Department of Orthopedics, The Fourth Affiliated Hospital of Nanjing Medical University
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Han L, Ma H, Li Q, Yuan J, Yang H, Qin Y, Lu X. The association of rod curvature with postoperative outcomes in patients undergoing posterior lumbar interbody fusion for spinal stenosis: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:304. [PMID: 37072780 PMCID: PMC10111816 DOI: 10.1186/s12891-023-06404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 04/06/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Restoration of sagittal balance is a crucial consideration in posterior lumbar interbody fusion (PLIF) surgery and adverse postoperative outcomes are associated with inadequate restoration of sagittal alignment. However, there remains a shortage of substantial evidence regarding the effect of rod curvature on both sagittal spinopelvic radiographic parameters and clinical outcomes. METHOD A retrospective case-control study was conducted in this study. Patient demographics (age, gender, height, weight and BMI), surgical characteristics (number of fused levels, surgical time, blood loss and hospital stay) and radiographic parameters (lumbar lordosis [LL], sacral slope [SS], pelvic incidence [PI], pelvic tilt [PT], PI-LL, Cobb angle of fused segments [Cobb], rod curvature [RC], Posterior tangent angle of fused segments [PTA] and RC-PTA) were analyzed. RESULTS Patients in the abnormal group had older mean age and suffered more blood loss than those in the normal group. In addition, RC and RC-PTA were significantly lower in the abnormal group compared to the normal group. Multivariate regression analysis revealed that lower age (OR = 0.94; 95% CI: 0.89-0.99; P = 0.0187), lower PTA (OR = 0.91; 95% CI: 0.85-0.96; P = 0.0015) and higher RC (OR = 1.35; 95% CI: 1.20-1.51; P < 0.0001) were related to higher odds of better surgical outcomes. The receiver operating characteristic curve analysis showed that the ROC curve (AUC) for predicting outcomes of surgery by RC classifier was 0.851 (0.769-0.932). CONCLUSIONS In patients who underwent PLIF surgery for lumbar spinal stenosis, those who had a satisfactory postoperative outcome tended to be younger, had lower blood loss, and higher values of RC and RC-PTA compared to those who had poor recovery and required revision surgery. Additionally, RC was found to be a reliable predictor of postoperative outcomes.
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Affiliation(s)
- Lin Han
- Department of Orthopaedics, Third Affiliated Hospital of Naval Medical University, Shanghai, 200433, China
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Hongdao Ma
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Qisheng Li
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Jincan Yuan
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Haisong Yang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Yuchen Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, 200003, China.
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
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Sengul E, Ozmen R, Demir T. The effects of pre-stressed rods contoured by different bending techniques on posterior instrumentation of L4-L5 lumbar spine segment: A finite element study. Proc Inst Mech Eng H 2022; 236:960-972. [DOI: 10.1177/09544119221096582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Posterior pedicle screw instrumentation (PPSI) is a well-known method in lumbar spine surgery. Understanding how PPSI affects the biomechanics of the lumbar spine is an important issue. In particular, during PPSI operations, surgeons bend rods according to the patients’ spinal curvatures based on their own experiences. As a result, residual stresses develop on the rods due to this bending. Although many finite element-based biomechanical studies have been performed for PPSI, studies comparing the effects of residual stresses arising from rod contouring on the construct stresses are lacking. Thus, this study aimed to investigate the effects of residual stress in PPSI using rods contoured with a French bender and an in-situ bender, as well as comparing the differences in stress increment with straight and contoured rods for different physiological motions. Accordingly, a finite element (FE) model of the L4-L5 lumbar spine segment was developed for PPSI and the effects of residual stresses on rods were investigated by using different bending methods. In the simulations, it was found that rods contoured with a French bender with residual stress resulted in significantly more increased stress in PPSI compared to those contoured with an in-situ bender. The results of this study emphasize that increased stress in PPSI due to the residual stresses for different physiological motions may increase the risk of PPSI failures. Additionally, the finite element modeling approach employed here could be used as a fundamental tool for further investigations of topics such as PPSI fatigue life and failure studies.
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Affiliation(s)
- Emre Sengul
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Çankaya, Ankara, Turkey
- Mechanical Engineer, Roketsan Inc., Lalahan, Ankara, Turkey
| | - Ramazan Ozmen
- Department of Mechatronics Engineering, Karabük University, Merkez, Karabük, Turkey
| | - Teyfik Demir
- Department of Mechanical Engineering, TOBB University of Economics and Technology, Çankaya, Ankara, Turkey
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Han L, Li Y, Li Z, Ma H, Wang C, Chen Q, Lu X. Biomechanical and Clinical Study of Rod Curvature in Single-Segment Posterior Lumbar Interbody Fusion. Front Bioeng Biotechnol 2022; 10:824688. [PMID: 35309996 PMCID: PMC8929399 DOI: 10.3389/fbioe.2022.824688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: Pedicle screw fixation is a common technique used in posterior lumbar interbody fusion (PLIF) surgery for lumbar disorders. During operation, rod contouring is often subjective and not satisfactory, but only few studies focused on the rod-contouring issue previously. The aim of the study was to explore the effect of the rod contouring on the single-segment PLIF by the finite element (FE) method and retrospective study. Methods: A FE model of the lumbosacral vertebrae was first reconstructed, and subsequently single-segmental (L4/5) PLIF surgeries with four rod curvatures (RCs) were simulated. Herein, three RCs were designed by referring to centroid, Cobb, and posterior tangent methods applied in the lumbar lordosis measurement, and zero RC indicating straight rods was included as well. Clinical data of patients subjected to L4/5 segmental PLIF were also analyzed to verify the correlation between RCs and clinical outcome. Results: No difference was observed among the four RC models in the range of motion (ROM), intersegmental rotation angle (IRA), and intradiscal pressure (IDP) under four actions. The posterior tangent model had less maximum stress in fixation (MSF) in flexion, extension, and axial rotation than the other RC models. Patients with favorable prognosis had larger RC and positive RC minus posterior tangent angle (RC-PTA) of fused segments with respect to those who had poor prognosis and received revision surgery. Conclusion: All RC models had similar biomechanical behaviors under four actions. The posterior tangent-based RC model was superior in fixation stress distribution compared to centroid, Cobb, and straight models. The retrospective study demonstrated that moderate RC and positive RC-PTA were associated with better postoperative results.
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Affiliation(s)
- Lin Han
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yongheng Li
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- School of Mechanical Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
| | - Hongdao Ma
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenfeng Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
- *Correspondence: Qiang Chen, ; Xuhua Lu,
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Qiang Chen, ; Xuhua Lu,
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