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J Clin Neurosci. 2019 Jan;59:248-253. doi: 10.1016/j.jocn.2018.08.017. Epub 2018 Sep 29.

Pre-operative planning and rod customization may optimize post-operative alignment and mitigate development of malalignment in multi-segment posterior cervical decompression and fusion patients.

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Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. Electronic address:
Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA.
Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.


Patient-specific rods designed based on a particular pre-operative plan are a recent advancement to help achieve desired operative alignment goals. This study investigated the role of pre-operative planning and patient-specific rods on post-operative alignment and outcomes. Patients were grouped according to use of pre-operative planning and patient-specific, pre-contoured rods (PLAN) or absence of planning/rods (NON). Pre-operative and post-operative alignment were measured: cervical sagittal vertical axis (cSVA), cervical lordosis (CL), T1 Slope minus CL (TS-CL). Alignment differences between the groups were assessed using independent and paired samples t-tests. 34 patients were identified (15 PLAN, 19 NON). Pre- and post-operative CL, cSVA and TS were similar between the two groups (p > 0.05), though pre-operative TS-CL was slightly higher in PLAN patients (28.13° versus 18.42°, p = 0.049). There were no improvement differences pre- to post-operative for CL, cSVA and TS between the groups (p > 0.05). However, PLAN patients exhibited a greater correction of TS-CL, with an average of 5.8° decrease versus a 3.5° increase in TS-CL for NON patients (p = 0.015). PLAN patients did not demonstrate a significant change from pre- to post-operative alignment for cSVA or TS-CL (cSVA: 27.5 mm to 31.1 mm, p = 0.255; TS-CL: 28.1° to 22.3°, p = 0.13), though their TS-CL did trend towards significant post-operative improvement. In contrast, NON patients worsened in cSVA and TS-CL post-operatively (cSVA: 21.8 mm to 30.3 mm, p < 0.001; TS-CL: 18.4° to 22.0°, p = 0.035). Multi-segment posterior decompression and fusion patients have the potential to worsen with regards to post-operative alignment without pre-operative planning. Patients with pre-contoured rods and pre-operative planning exhibited a greater correction of TS-CL after surgery than un-planned cases, though limited by the pre-operative difference in cervical-thoracic mismatch between planned and unplanned cases. LEVELS OF EVIDENCE: III.


Patient-specific rods; Posterior cervical surgery; Pre-contoured rods; Pre-operative planning; Sagittal alignment

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