CT-Based Analysis of Rod Trace Length Changes During Posterior Spinal Correction in Adult Spinal Deformity

Background: In adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily performed in the coronal plane, and rod length changes are relatively predictable. Moreover, PJK is uncommon in AIS, making excess rod length rarely a clinical concern. In contrast, ASD correction involves more complex three-dimensional realignment, including restoration of lumbar lordosis (LL), which makes it challenging to predict postoperative changes in rod trace length (RTL). Furthermore, because PJK occurs more frequently in ASD surgery, appropriate rod length selection becomes clinically important. This study aimed to quantitatively evaluate changes in RTL before and after posterior correction. Method: Thirty patients with ASD who underwent staged lateral lumbar interbody fusion (LLIF) followed by posterior corrective fusion from T9 to the pelvis were retrospectively analyzed. RTL before posterior correction (Pre-RTL) was estimated from the planned screw insertional point on axial CT after LLIF, and postoperative RTL (Post-RTL) was measured from screw head centers on post-operative CT. LL and Cobb angle were assessed before and after posterior correction. Correlations between RTL change and alignment change were evaluated. Results: Postoperative RTL was shortened in all patients, with an average reduction of approximately 16-17 mm. RTL shortening demonstrated significant correlations with LL correction (R = 0.51, p = 0.003) and Cobb angle correction (R = 0.70, p = 0.00001). Greater shortening of RTL was observed on the convex side in patients with preoperative Cobb angle ≥ 10° (p = 0.04). Conclusions: Greater coronal deformity, particularly on the convex side, was associated with increased RTL shortening. These findings suggest that routine preparation of excessively long rods may be unnecessary. Consideration of anticipated RTL shortening may help avoid excessive cranial rod length and potentially reduce the risk of skin complications associated with PJK, particularly in thin elderly patients.