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World Neurosurg. 2017 Oct;106:905-911. doi: 10.1016/j.wneu.2017.07.061. Epub 2017 Jul 20.

The Fate of Patients with Adult Spinal Deformity Incurring Rod Fracture After Thoracolumbar Fusion.

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Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Electronic address:
Department of Orthopedic Surgery, NYU Langone Orthopedics, New York, New York, USA.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Vancouver Spine Surgery Institute, Vancouver General Hospital, Vancouver, Canada.
Department of Orthopedic Surgery, Washington University Orthopedics, St. Louis, Missouri, USA.
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Neurological Surgery, University of California at San Francisco, San Francisco, California, USA.
Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, California, USA.
Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA.
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, Oregon, USA.



To report the outcome of adult spinal deformity (ASD) in patients with rod fracture (RF) after thoracolumbar fusion.


Retrospective review of prospective, multicenter database. Operative patients with ASD ≥18 years old with RF after ASD surgery and with a minimum 6-month follow-up after RF were included. Health-related quality of life scores and radiographic alignment were compared with nonparametric paired and independent testing (P < 0.05).


A total of 51 of 343 patients with ASD (14.9%) sustained a RF, of whom 44 (86.3%) had at least 6-month follow up after RF (mean age = 61.2 years, mean body mass index = 29.6 kg/m2). Mean total follow-up was 37.8 months (range 24.5-66.7 months). Interbody fusion was used in 26 cases of RF (59.1%) (transforaminal lumbar interbody fusion, n = 17 [65.4%], anterior lumbar interbody fusion, n = 5 [19.2%]). RF was symptomatic in 26 of 44 (59.1%) of patients and discovered incidentally in 18 of 44 patients (40.9%). Overall, 28 RFs were revised (63.6%); 12 of 23 (52.2%) unilateral RF and 16 of 21 (76.2%) bilateral RF at last follow-up. Revision patients were significantly more likely to be symptomatic at the time of RF detection (78.6% vs. 25.0%, P = 0.0006), and had significantly worse Oswestry Disability Index and Scoliosis Research Society-22r pain scores.


RFs were detected in 14.9% of patients with ASD and were most common at the L4-L5 and L5-S1 levels. Approximately 63.6% of patients underwent revision surgery. The decision to perform revision surgery may be based predominantly on symptoms referable to the RF, pain, and perceived disability, as radiographic parameters at the time of RF did not differ significantly between patients who did and did not undergo revision.


Adult spinal deformity; Health-related quality of life; Oswestry Disability Index; Pedicle subtraction osteotomy; Revision; Rod fracture

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