Skip to main content

Multiple-rod constructs in adult spinal deformity surgery for pelvic-fixated long instrumentations: an integral matched cohort analysis



Multiple-rod constructs (Multi-Rod: extra rods for additional pillar support) are occasionally used in adult spinal deformity (ASD) surgery. We aimed to compare and analyze the general outcome of multi-rod constructs with a matched two-rod cohort, to better understand the differences and the similitudes.


This is a retrospective matched cohort study including patients with ASD that underwent surgical correction with long posterior instrumentation (more than five levels), pelvic fixation and a minimum 1-year follow-up. Matching was considered with demographical data, preoperative radiographical parameters, preoperative clinical status [health-related quality-of-life (HRQoL) scores] and surgical characteristics (anterior fusion, decompression, rod material, osteotomies). Postoperative radiographical and clinical parameters, as well as complications, were obtained. Univariate and multivariate analysis was performed regarding postoperative improvement, group variables comparison and parameters correlation.


Thirty-three patients with multi-rod construct and 33 matched with a two-rod construct were selected from a database with 346 ASD-operated patients. Both groups had a significant improvement with surgical management in the radiographical and HRQoL parameters (p < 0.001). Differences between groups for the postoperative radiographical, clinical and perioperative parameters were not significant. Rod breakage was more frequent in the two-rod group (8 vs 4, p = 0.089), as well as the respective revision surgery for those cases (6 vs 1 p = 0.046). Risk factors related to revision surgery were greater kyphosis correction (p = 0.001), longer instrumentation (p = 0.037) and greater sagittal vertical axis correction (p = 0.049).


No major disadvantage on the use of multi-rod construct was identified. This supports the benefit of using multi-rod constructs to avoid implant failure.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Graham RB, Sugrue PA, Koski TR (2016) Adult degenerative scoliosis. Clin Spine Surg 29(3):95–107.

    Article  PubMed  Google Scholar 

  2. Wang G, Hu J, Liu X, Cao Y (2015) Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J 24(8):1792–1799.

    Article  PubMed  Google Scholar 

  3. Schwab F, Blondel B, Bess S et al (2013) Radiographical spinopelvic parameters and disability in the setting adult spinal deformity. Spine 2013(38):803–812

    Article  Google Scholar 

  4. Takemoto M, Boissière L, Vital JM, Pellisé F, Perez-Grueso FJS, Kleinstück F, Acaroglu ER, Alanay A, Obeid I (2017) Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J 26(8):2176–2186.

    Article  PubMed  Google Scholar 

  5. Zeng Y, White AP, Albert TJ, Chen Z (2012) Surgical strategy in adult lumbar scoliosis: the utility of categorization into 2 groups based on primary symptom, each with 2-year minimum follow-up. Spine (Phila Pa 1976). 37(9):E556–E561.

    Article  Google Scholar 

  6. Fujishiro T, Boissière L, Cawley DT, Larrieu D, Gille O, Vital JM, Pellisé F, Pérez-Grueso FJS, Kleinstück F, Acaroglu E, Alanay A, Obeid I, European Spine Study Group, ESSG (2018) Decision-making factors in the treatment of adult spinal deformity. Eur Spine J 27(9):2312–2321.

    Article  PubMed  Google Scholar 

  7. Pichelmann MA, Lenke LG, Bridwell KH, Good CR, OLeary PT, Sides BA (2010) Revision rates following primary adult spinal deformity surgery six hundred forty-three consecutive patients followed up to twenty two years postoperative. Spine (Phila Pa 1976) 35(2):219–226

    Article  Google Scholar 

  8. Shen FH, Qureshi R, Tyger R, Lehman R, Singla A, Shimer A, Hassanzadeh H (2018) Use of the “dual construct” for the management of complex spinal reconstructions. Spine J 18(3):482–490

    Article  Google Scholar 

  9. Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM (2014) Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976) 39(22):1899–1904

    Article  Google Scholar 

  10. Palumbo MA, Shah KN, Eberson CP, Hart RA, Daniels AH (2015) Outrigger rod technique for supplemental support of posterior spinal arthrodesis. Spine J 15(6):1409–1414

    Article  Google Scholar 

  11. Han S, Hyun SJ, Kim KJ, Jahng TA, Lee S, Rhim SC (2017) Rod stiffness as a risk factor of proximal junctional kyphosis after adult spinal deformity surgery: comparative study between cobalt chrome multiple-rod constructs and titanium alloy two-rod constructs. Spine J 17(7):962–968

    Article  Google Scholar 

  12. Merrill RK, Kim JS, Leven DM, Kim JH, Cho SK (2017) Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Glob Spine J 7(6):514–520.

    Article  Google Scholar 

  13. Luca A, Ottardi C, Sasso M, Prosdocimo L, La Barbera L, Brayda-Bruno M, Galbusera F, Villa T (2017) Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs. Eur Spine J 26(3):764–770.

    Article  PubMed  Google Scholar 

  14. Hallager DW, Gehrchen M, Dahl B, Harris JA, Gudipally M, Jenkins S, Wu AM, Bucklen BS (2016) Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study. Spine (Phila Pa 1976). 41(7):E388–E395.

    Article  Google Scholar 

  15. Kelly BP, Shen FH, Schwab JS, Arlet V, Diangelo DJ (2008) Biomechanical testing of a novel four-rod technique for lumbo-pelvic reconstruction. Spine (Phila Pa 1976) 33(13):E400–E406

    Article  Google Scholar 

  16. Lazennec JY, Brusson A, Folinais D, Zhang A, Pour AE, Rousseau MA (2015) Measuring extension of the lumbar-pelvic-femoral complex with the EOS® system. Eur J Orthop Surg Traumatol 25(6):1061–1068.

    CAS  Article  PubMed  Google Scholar 

  17. Obeid I, Hauger O, Aunoble S, Bourghli A, Pellet N, Vital JM (2011) Global analysis of sagittal spinal alignment in major deformities: correlation between lack of lumbar lordosis and flexion of the knee. Eur Spine J 20(S5):681–685

    Article  Google Scholar 

  18. Boissière L, Vital JM, Aunoble S, Fabre T, Gille O, Obeid I (2015) Lumbo-pelvic related indexes: impact on adult spinal deformity surgery. Eur Spine J 24(6):1212–1218.

    Article  PubMed  Google Scholar 

  19. Obeid I, Bourghli A, Larrieu D, Laouissat F, Challier V, Pointillart V, Gille O, Vital JM, Senegas J, Boissière L (2016) The global tilt: evaluation of a parameter considering the global spinopelvic alignment. J Med Liban 64(3):146–151

    PubMed  Google Scholar 

  20. Yuksel S, Ayhan S, Nabiyev V, Domingo-Sabat M, Vila Casademunt A, Obeid I, Perez-Grueso FS, Acaroglu E, European Spine Study Group (ESSG) (2018) Minimum clinically important difference of the health related quality of life scales in adult spinal deformity calculated by latent class analysis is it appropriate to use the same values for surgical and nonsurgical patients. Spine J pii S1529-9430(18):30650–30658.

    Article  Google Scholar 

  21. Soroceanu A, Diebo BG, Burton D, Smith JS, Deviren V, Shaffrey C, Kim HJ, Mundis G, Ames C, Errico T, Bess S, Hostin R, Hart R, Schwab F, Lafage V, International Spine Study Group (2015) Radiographical and implant-related complications in adult spinal deformity surgery: incidence, patient risk factors, and impact on Health-Related Quality of Life. Spine (Phila Pa 1976) 40(18):1414–1421.

    Article  Google Scholar 

  22. Ahn YH, Chen WM, Lee KY, Park KW, Lee SJ (2008) Comparison of the load-sharing characteristics between pedicle-based dynamic and rigid rod devices. Biomed Mater 3(4):044101.

    CAS  Article  PubMed  Google Scholar 

  23. Daniels AH, DePasse JM, Durand W, Hamilton DK, Passias P, Kim HJ, Protopsaltis T, Reid DBC, LaFage V, Smith JS, Shaffrey C, Gupta M, Klineberg E, Schwab F, Burton D, Bess S, Ames C, Hart RA, International Spine Study Group (2018) Rod fracture after apparently solid radiographic fusion in adult spinal deformity patients. World Neurosurg 117:e530–e537

    Article  Google Scholar 

  24. Bourghli A, Boissiere L, Larrieu D, Vital JM, Yilgor C, Pellisé F, Alanay A, Acaroglu E, Perez-Grueso FJ, Kleinstück F, Obeid I, European Spine Study Group (2017) Lack of improvement in health-related quality of life (HRQOL) scores 6 months after surgery for adult spinal deformity (ASD) predicts high revision rate in the second postoperative year. Eur Spine J 26(8):2160–2166.

    Article  PubMed  Google Scholar 

  25. Shen FH, Mason JR, Shimer AL, Arlet VM (2013) Pelvic fixation for adult scoliosis. Eur Spine J Suppl 2:S265–S275.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fernando Guevara-Villazón.

Ethics declarations

Conflict of interest

There are no conflicts of interest for this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PPTX 139 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Guevara-Villazón, F., Boissiere, L., Hayashi, K. et al. Multiple-rod constructs in adult spinal deformity surgery for pelvic-fixated long instrumentations: an integral matched cohort analysis. Eur Spine J 29, 886–895 (2020).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Multiple-rod construct
  • Adult spinal deformity
  • Adult scoliosis
  • Rod breakage
  • Pseudarthrosis
  • Pelvic fixation