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Use of the "dual construct" for the management of complex spinal reconstructions
Francis H Shen1, Rabia Qureshi1, Rose Tyger1
1Department of Orthopaedic Surgery, Spine Center, Division of Spine Surgery, University of Virginia, PO Box 800159 HSC, Charlottesville, VA 22908, USA.
Background Context:
Surgical management of complex spinal reconstructions remains a clinical challenge, as pseudoarthrosis with subsequent rod breakage can occur. Increased rod density in the form of "satellite" or "outrigger" rods have been described; however, rod-fracture above or below satellite rods persist and can result in dissociation of the construct, loss of correction, and recurrence of deformity. The use of four distinct and mechanically independent rods (dual construct) reduces this concern. Since the original case description in 2006, there have been no other studies that use the dual construct for the surgical management of complex spinal reconstructions.
Purpose:
The purpose of this study is to review the long-term experience and surgical technique using the dual construct, and to present our complications, rod fracture rates, and outcomes for the surgical management of complex spinal reconstructions.
Study Design:
This study used a surgical technique with case series outcomes.
Patient Sample:
Patients were from a single-institute who underwent dual construct between 2010 and 2014 and who were available for 2-year follow-up.
Outcome Measures:
Radiographic and functional outcomes, complications, rod fracture rates, and revision surgery rates were the outcome measures.
Methods:
A retrospective review was conducted from a single institution between 2010 and 2014, with a subsequent 2-year follow-up period. Extensive review of patients' medical record, radiographs, and advanced imaging where available was performed. Medical record was evaluated for patient demographics, surgical procedure, and complications. Radiographic measurements included presence or absence of implant failure and proximal junctional kyphosis or distal junctional kyphosis.
Results:
A total of 36 patients underwent surgical reconstruction. The average estimated blood loss was 1,856 cc (range, 400-4,000 cc). The average length of stay was 7.3 days (range, 4-22 days). Clinical follow-up reported 21 patients (58.3%) with no or minimal pain. There were six deaths during the follow-up unrelated to the index procedure. Radiographic follow-up revealed three patients (8.3%) with rod fracture; one patient with one rod fracture, and two patients with two rod fractures. No patient had three or all four rod fractures. There were no screw fractures. None of the patients with rod fractures required revision surgery.
Conclusions:
The biggest advantage of the dual construct is that rod breakage, although uncommon, is typically minimal, or asymptomatic, and more importantly does not result in loss of alignment, and therefore has not required revision surgery. The dual construct approach is a safe alternative to traditional two-rod constructs, with encouraging outcomes at follow-up.
