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Comparison of degenerative lumbar scoliosis correction and risk for mechanical failure using posterior 2-rod instrumentation versus 4-rod instrumentation and interbody fusion

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Abstract

Purpose

Four-rod instrumentation and interbody fusion may reduce mechanical complications in degenerative scoliosis surgery compared to 2-rod instrumentation. The purpose was to compare clinical results, sagittal alignment and mechanical complications with both techniques.

Methods

Full spine radiographs were analysed in 97 patients instrumented to the pelvis: 58 2-rod constructs (2R) and 39 4-rod constructs (4R). Clinical scores (VAS, ODI, SRS-22, EQ-5D-3L) were assessed preoperatively, at 3 months, 1 year and last follow-up (average 4.2 years). Radiographic measurements were: thoracic kyphosis, lumbar lordosis, spinopelvic parameters, segmental lordosis distribution. The incidence of non-union and PJK were investigated.

Results

All clinical scores improved significantly in both groups between preoperative and last follow-up. In the 2R-group, lumbar lordosis increased to 52.8° postoperatively and decreased to 47.0° at follow-up (p = 0.008). In the 4R-group, lumbar lordosis increased from 46.4 to 52.5° postoperatively and remained at 53.4° at follow-up. There were 8 (13.8%) PJK in the 2R-group versus 6 (15.4%) in the 4R-group, with a mismatch between lumbar apex and theoretic lumbar shape according to pelvic incidence. Non-union requiring revision surgery occurred on average at 26.9 months in 28 patients (48.3%) of the 2R-group. No rod fracture was diagnosed in the 4R-group.

Conclusion

Multi-level interbody fusion combined with 4-rod instrumentation decreased risk for non-union and revision surgery compared to select interbody fusion and 2-rod instrumentation. The role of additional rods on load sharing still needs to be determined when multiple cages are used. Despite revision surgery in the 2R group, final clinical outcomes were similar in both groups.

Level of evidence

III.

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Funding

All the authors participated in the study with no study funding involved.

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Authors and Affiliations

  1. Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France

    Vincent Lamas, Yann Philippe Charles & Jean-Paul Steib

  2. Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France

    Nicolas Tuzin

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  1. Vincent Lamas
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Correspondence to Vincent Lamas.

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Conflict of interest

Vincent Lamas has no conflict of interest. Yann Philippe Charles is a consultant for Stryker, Clariance and Ceraver; he received royalties and grants unrelated to this study from Stryker and Clariance. Nicolas Tuzin has no conflict of interest. Jean-Paul Steib is a consultant for Clariance and Zimmer-Biomet; he received royalties from Clariance, Zimmer-Biomet and Medtronic.

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Lamas, V., Charles, Y.P., Tuzin, N. et al. Comparison of degenerative lumbar scoliosis correction and risk for mechanical failure using posterior 2-rod instrumentation versus 4-rod instrumentation and interbody fusion. Eur Spine J 30, 1965–1977 (2021). https://doi.org/10.1007/s00586-021-06870-9

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  • DOI: https://doi.org/10.1007/s00586-021-06870-9

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