{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:57:11Z","timestamp":1793195831646,"version":"4.5.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Improved understanding of rod fracture (RF) following adult spinal deformity (ASD) surgery could prove valuable for surgical planning, patient counseling, and implant design. The objective of this study was to prospectively assess the rates of and risk factors for RF following surgery for ASD.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This was a prospective, multicenter, consecutive series. Inclusion criteria were ASD, age &gt; 18 years, \u22655 levels posterior instrumented fusion, baseline full-length standing spine radiographs, and either development of RF or full-length standing spine radiographs obtained at least 1 year after surgery that demonstrated lack of RF. ASD was defined as presence of at least one of the following: coronal Cobb angle \u226520\u00b0, sagittal vertical axis (SVA) \u22655 cm, pelvic tilt (PT) \u226525\u00b0, and thoracic kyphosis \u226560\u00b0.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Of 287 patients who otherwise met inclusion criteria, 200 (70%) either demonstrated RF or had radiographic imaging obtained at a minimum of 1 year after surgery showing lack of RF. The patients' mean age was 54.8 \u00b1 15.8 years; 81% were women; 10% were smokers; the mean body mass index (BMI) was 27.1 \u00b1 6.5; the mean number of levels fused was 12.0 \u00b1 3.8; and 50 patients (25%) had a pedicle subtraction osteotomy (PSO). The rod material was cobalt chromium (CC) in 53%, stainless steel (SS), in 26%, or titanium alloy (TA) in 21% of cases; the rod diameters were 5.5 mm (in 68% of cases), 6.0 mm (in 13%), or 6.35 mm (in 19%). RF occurred in 18 cases (9.0%) at a mean of 14.7 months (range 3\u201327 months); patients without RF had a mean follow-up of 19 months (range 12\u201324 months). Patients with RF were older (62.3 vs 54.1 years, p = 0.036), had greater BMI (30.6 vs 26.7, p = 0.019), had greater baseline sagittal malalignment (SVA 11.8 vs 5.0 cm, p = 0.001; PT 29.1\u00b0 vs 21.9\u00b0, p = 0.016; and pelvic incidence [PI]\u2013lumbar lordosis [LL] mismatch 29.6\u00b0 vs 12.0\u00b0, p = 0.002), and had greater sagittal alignment correction following surgery (SVA reduction by 9.6 vs 2.8 cm, p &lt; 0.001; and PI-LL mismatch reduction by 26.3\u00b0 vs 10.9\u00b0, p = 0.003). RF occurred in 22.0% of patients with PSO (10 of the 11 fractures occurred adjacent to the PSO level), with rates ranging from 10.0% to 31.6% across centers. CC rods were used in 68% of PSO cases, including all with RF. Smoking, levels fused, and rod diameter did not differ significantly between patients with and without RF (p &gt; 0.05). In cases including a PSO, the rate of RF was significantly higher with CC rods than with TA or SS rods (33% vs 0%, p = 0.010). On multivariate analysis, only PSO was associated with RF (p = 0.001, OR 5.76, 95% CI 2.01\u201315.8).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Rod fracture occurred in 9.0% of ASD patients and in 22.0% of PSO patients with a minimum of 1-year follow-up<jats:italic>.<\/jats:italic> With further follow-up these rates would likely be even higher. There was a substantial range in the rate of RF with PSO across centers, suggesting potential variations in technique that warrant future investigation. Due to higher rates of RF with PSO, alternative instrumentation strategies should be considered for these cases.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.9.spine131176","type":"journal-article","created":{"date-parts":[[2014,10,17]],"date-time":"2014-10-17T14:01:07Z","timestamp":1413554467000},"page":"994-1003","source":"Crossref","is-referenced-by-count":250,"title":["Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity"],"prefix":"10.3171","volume":"21","author":[{"given":"Justin S.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacramento;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"University of California San Diego, School of Medicine, San Diego;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"San Diego Center for Spinal Disorders, La Jolla;\u00a0"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming G.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical College, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, Sacramento;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hostin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vedat","family":"Deviren","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Kebaish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas C.","family":"Burton","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; 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