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KMID : 1189320230170050985
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Asian Spine Journal
2023 Volume.17 No. 5 p.985 ~ p.995
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Multiple-Rod Constructs in Adult Spinal Deformity Surgery: A Systematic Review and Meta-Analysis
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Jian Zhao
Zheng Nie
Zhengping Zhang
Dongfa Liao
Da Liu
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Abstract
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The purpose of this research was to compare the therapeutic efficacy of multiple-rod constructs vis-a-vis 2-rod constructs in the treatment of adult spinal deformity. A systematic review and meta-analysis were performed to determine whether the multiple-rod construct outperformed the 2-rod construct. We initially retrieved 357 papers, but only 12 were chosen for further meta-analysis. The rod breakage rates in the multiple-rod and the 2-rod groups were 10.66% and 29.87%, respectively. The multiple-rod construct inhibited rod breakage (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.19?0.41; p<0.001), pseudarthrosis (OR, 0.30; 95% CI, 0.18?0.50; p<0.001) and rod fracture at the osteotomy site (OR, 0.34; 95% CI, 0.13?0.89; p=0.03). Furthermore, the multiple-rod construct reduces the risk of revision surgery (OR, 0.38; 95% CI, 0.20?0.73; p=0.04) as well as the revision risk of pseudarthrosis/rod fracture in the multiple-rod group (OR, 0.31; 95% CI, 0.18?0.52; p<0.001), but increases the risk of caudal screw loosening (OR, 4.99; 95% CI, 1.87?13.30; p=0.001). There was no statistically significant difference in proximal junctional kyphosis (PJK) parameters (p=0.85), cerebrospinal fluid leakage (p=0.09), wound infection (p=0.71), age at surgery (p=0.62), gender distribution (p=0.93), body mass index (p=0.86), smoking status (p=0.05), hospital stay (p=0.09), osteoporosis (p=0.95), CoCr rod material (p=0.15), bone morphogenetic protein-2 (p=0.58), L5/S1 interbody fusion (p=0.07), high-grade osteotomies (p=0.07), the number of fusion levels (p=0.11), operation time (p=0.30), and blood loss volume (p=0.34). Regarding radiographic parameters, only preoperative sagittal vertical axis was found to be higher (weight means difference [WMD], 25.60; 95% CI, 15.43?35.77; p<0.001) in the multiple-rod group. There was no difference in preoperative Oswestry Disability Index (ODI) (WMD, ?3.32; 95% CI, ?7.38 to 0.73; p=0.11), but the multiple-rod group had a lower ODI at follow-up (WMD, ?7.71; 95% CI, ?11.62 to ?3.86; p<0.001). Multiple-rod constructs could prevent rod breakage and pseudarthrosis while also lowering the revision rate, resulting in a better clinical outcome than the 2-rod construct. Nonetheless, due consideration should be given to PJK and screw loosening in multiple-rod constructs, possibly due to the increased stiffness caused by the multiple-rod structure.
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KEYWORD
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Adult spinal deformity, Multiple-rod, Rod fracture
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Listed journal information
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