{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:52:40Z","timestamp":1786125160325,"version":"build-2736575974"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Pedicle subtraction osteotomy (PSO) can be used to treat rigid sagittal plane deformities. Nonunions and rod breakages are known complications of PSO.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To assess outcomes of 2 methods of posterior instrumentation for PSO, traditional 2 rods vs a novel 4-rod technique in which 2 additional rods span only the osteotomy level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This study was a retrospective, radiographic review of consecutive PSOs performed at 2 centers. The primary difference in technique between the centers was the use of 4 rods including 2 independent rods attached only to the vertebral levels immediately adjacent to the PSO (group 1, n =\u00a029 patients) vs the traditional 2-rod technique (group 2, n =\u00a020 patients).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Demographics and preoperative to postoperative radiographic measurements were similar between the study groups, including the PSO wedge resection angle (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0= .56). The rod breakage rate was 25% with 2 rods and 0% with 4 rods (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0= .008), and the pseudarthrosis rate with 2 rods was 25% and with 4 rods was 3.4% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u00a0= .035). The patient with pseudarthrosis from group 1 had an infection and developed pseudarthrosis only after instrumentation removal. Rates of other complications did not differ significantly between the study groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>This study provides a comparison between 2 techniques for rod placement across a PSO and suggests that the described novel 4-rod technique may help to reduce the rates of pseudarthrosis and rod failure. It will be important to confirm these findings in a prospectively designed study with multiple institutions in order to better control for potentially confounding factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ons\/opx151","type":"journal-article","created":{"date-parts":[[2017,7,7]],"date-time":"2017-07-07T02:10:26Z","timestamp":1499393426000},"page":"449-456","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":99,"title":["A Novel 4-Rod Technique Offers Potential to Reduce Rod Breakage and Pseudarthrosis in Pedicle Subtraction Osteotomies for Adult Spinal Deformity Correction"],"prefix":"10.1227","volume":"14","author":[{"given":"Sachin","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacra-mento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat Sakir","family":"Eksi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blythe","family":"Durbin-Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacra-mento, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4]]},"reference":[{"key":"bib1-20240909","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2106\/00004623-200403001-00007","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. 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