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The “kickstand rod” technique for correction of coronal malalignment: two-year clinical and radiographic outcomes

Abstract

Purpose

Restoring coronal alignment in spine deformity patients has been shown to play an important role in improving patient reported outcomes (PRO). Recently, the “kickstand rod” (KSR) technique was developed as a novel coronal correction method in complex spine deformity cases. The goal of the present study was to assess outcomes of this technique at two years of follow-up.

Methods

Consecutive, unique adult patients who underwent KSR constructs for coronal spinal malalignment between 2015 and 2019 with a minimum 2 year clinical and radiographic follow-up were identified. A KSR construct includes a more laterally placed iliac screw and additional rod that effectively depresses the ipsilateral ilium/pelvis for coronal correction, while serving as a buttress to prevent future loss of correction. Outcomes included revision for instrumentation-related complications, radiographic alignment, and PROs.

Results

Twenty patients were included with a mean age of 54 years [range: 20–73 years]. Mean follow-up time was 2.5 years [range: 2.0–5.0]. Mean number of levels fused was 17.3 [range: 10–24]. There were significant improvements in coronal alignment (CVA: 5.8 cm ± 2.6 cm vs. 1.7 cm ± 1.5 cm), sagittal alignment (SVA: 5.6 cm ± 5.9 cm vs. 1.6 cm ± 2.5 cm) and major Cobb angle (55º ± 32 vs. 26º ± 21) maintained at 2 years (p < 0.05). One patient experienced an asymptomatic fracture at the shank of the KSR iliac screw. There were significant improvements in Oswestry Disability Index and SRS-22 domains (p < 0.05).

Conclusion

The KSR technique is a safe and effective method for correcting coronal malalignment in complex spinal deformity patients with no revisions specific for the KSR or iliac screw and significantly improved PROs at a minimum two-year follow-up.

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Funding

No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

Authors

Contributions

VP: Contributed to the concept/design of the work, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. MR: Contributed to the concept/design of the work, analysis/interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. FMH: Contributed to the concept/design of the work, acquisition, analysis, and interpretation of the data, drafted the work, approved the version to be published, agrees to be accountable for all aspects of the work. JML: Contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work. ZMS: Contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work. RAL: Contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work. LGL: Contributed to the concept/design of the work, revised the work critically for important intellectual content, approved the final version to be published, agrees to be accountable for all aspects of the work.

Corresponding author

Correspondence to Varun Puvanesarajah.

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Conflict of interest

Lawrence G. Lenke has received grant support from AO Spine, International Spine Summit Group, Scoliosis Research Society, EOS Technology and Setting Scoliosis Straight Foundation as a study investigator. Ronald A. Lehman has received grant support from the Department of Defense as a study investigator. Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman, and Lawrence G. Lenke have received consulting fees from Medtronic. Joseph M. Lombardi has received consulting fees from Stryker. Lawrence G. Lenke has received consulting fees from Acuity Surgical and Abryx. Lawrence G. Lenke has received reimbursements from Broadwater, AO Spine, and Scoliosis Research Society for attending meetings/travel. Ronald A. Lehman and Lawrence G. Lenke have received royalties and are patent holders from Medtronic. Ronald A. Lehman has received royalties and is a patent holder from Stryker. Varun Puvanesarajah, Fthimnir M. Hassan, and Micheal Raad declare that they have no conflict of interest.

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IRB-AAAR6015.

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Informed consent was obtained from all individual participants included in the study.

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Puvanesarajah, V., Raad, M., Hassan, F.M. et al. The “kickstand rod” technique for correction of coronal malalignment: two-year clinical and radiographic outcomes. Spine Deform (2022). https://doi.org/10.1007/s43390-022-00564-y

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Keywords

  • Spine deformity
  • Scoliosis
  • Coronal malalignment
  • Kickstand rod
  • Spine surgery