{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:58:18Z","timestamp":1793195898461,"version":"4.5.0"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,6,1]]},"abstract":"<jats:p>The use of multirod constructs in the setting of adult spinal deformity (ASD) began to prevent rod fracture and pseudarthrosis near the site of pedicle subtraction osteotomies (PSOs) and 3-column osteotomies (3COs). However, there has been unclear and inconsistent nomenclature, both clinically and in the literature, for the various techniques of supplemental rod implantation. In this review the authors aim to provide the first succinct lexicon of multirod constructs available for the treatment of ASD, providing a universal nomenclature and definition for each type of supplementary rod. The primary rod of ASD constructs is the longest rod that typically spans from the bottom of the construct to the upper instrumented vertebrae. The secondary rod is shorter than the primary rod, but is connected directly to pedicle screws, albeit fewer of them, and connects to the primary rod via lateral connectors or cross-linkers. Satellite rods are a 4-rod technique in which 2 rods span only the site of a 3CO via pedicle screws at the levels above and below, and are not connected to the primary rod (hence the term \u201csatellite\u201d). Accessory rods are connected to the primary rods via side connectors and buttress the primary rod in areas of high rod strain, such as at a 3CO or the lumbosacral junction. Delta rods span the site of a 3CO, typically a PSO, and are not contoured to the newly restored lordosis of the spine, thus buttressing the primary rod above and below a 3CO. The kickstand rod itself functions as an additional means of restoring coronal balance and is secured to a newly placed iliac screw on the side of truncal shift and connected to the primary rod; distracting against the kickstand then helps to correct the concavity of a coronal curve. The use of multirod constructs has dramatically increased over the last several years in parallel with the increasing prevalence of ASD correction surgery. However, ambiguity persists both clinically and in the literature regarding the nomenclature of each supplemental rod. This nomenclature of supplemental rods should help unify the lexicon of multirod constructs and generalize their usage in a variety of scientific and clinical scenarios.<\/jats:p>","DOI":"10.3171\/2021.10.spine21745","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T02:18:17Z","timestamp":1640917097000},"page":"1023-1029","source":"Crossref","is-referenced-by-count":15,"title":["The lexicon of multirod constructs in adult spinal deformity: a concise description of when, why, and how"],"prefix":"10.3171","volume":"36","author":[{"given":"Wyatt L.","family":"Ramey","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona;"},{"name":"Department of Neurological Surgery and Neurological Institute, Houston Methodist Hospital, Texas Medical Center, Houston, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew S.","family":"Jack","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Division of Complex Spine, Swedish Neuroscience Institute, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1093\/neuros\/nyz454","article-title":"Epidemiology and socioeconomic trends in adult spinal deformity care","volume":"87","author":"Safaee MM","year":"2020","unstructured":"Safaee MM, Ames CP, Smith JS. Epidemiology and socioeconomic trends in adult spinal deformity care. Neurosurgery. 2020;87(1):25\u201332.3162079410.1093\/neuros\/nyz454"},{"issue":"suppl 1","key":"b2","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1227\/01.neu.0000462076.73701.09","article-title":"The comprehensive anatomical spinal osteotomy classification","volume":"76","author":"Schwab F","year":"2015","unstructured":"Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P,  The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2015;76(suppl 1):S33\u2013S41.2569236610.1227\/01.neu.0000462076.73701.09"},{"issue":"12","key":"b3","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1097\/BRS.0b013e31823e15e2","article-title":"Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study","volume":"37","author":"Schwab F","year":"2012","unstructured":"Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D,  Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976).2012;37(12):1077\u20131082.10.1097\/BRS.0b013e31823e15e222045006"},{"issue":"4","key":"b4","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1227\/NEU.0000000000000012","article-title":"The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort","volume":"73","author":"Terran J","year":"2013","unstructured":"Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP,  The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery. 2013;73(4):559\u2013568.2375675110.1227\/NEU.0000000000000012"},{"issue":"6","key":"b5","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"994","DOI":"10.3171\/2014.9.SPINE131176","article-title":"Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity","volume":"21","author":"Smith JS","year":"2014","unstructured":"Smith JS, Shaffrey E, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ,  Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014;21(6):994\u20131003.2532517510.3171\/2014.9.SPINE131176"},{"issue":"4","key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"862","DOI":"10.1227\/NEU.0b013e3182672aab","article-title":"Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity","volume":"71","author":"Smith JS","year":"2012","unstructured":"Smith JS, Shaffrey CI, Ames CP, Demakakos J, Fu KM, Keshavarzi S,  Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery. 2012;71(4):862\u2013867.2298996010.1227\/NEU.0b013e3182672aab"},{"issue":"14","key":"b7","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1198","DOI":"10.1097\/BRS.0b013e31824fffde","article-title":"Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures","volume":"37","author":"Auerbach JD","year":"2012","unstructured":"Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D,  Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976).2012;37(14):1198\u20131210.10.1097\/BRS.0b013e31824fffde22366971"},{"issue":"suppl 1","key":"b8","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"44","DOI":"10.2106\/00004623-200403001-00007","article-title":"Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance Surgical technique","volume":"86-A","author":"Bridwell KH","year":"2004","unstructured":"Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance Surgical technique. J Bone Joint Surg Am. 2004;86-A(suppl 1):44\u201350.10.2106\/00004623-200403001-00007"},{"issue":"20","key":"b9","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2238","DOI":"10.1097\/BRS.0b013e31814cf24a","article-title":"Adult spinal deformity surgery: complications and outcomes in patients over age 60","volume":"32","author":"Daubs MD","year":"2007","unstructured":"Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH. Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976).2007;32(20):2238\u20132244.10.1097\/BRS.0b013e31814cf24a17873817"},{"issue":"22","key":"b10","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1899","DOI":"10.1097\/BRS.0000000000000556","article-title":"Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies","volume":"39","author":"Hyun SJ","year":"2014","unstructured":"Hyun SJ, Lenke LG, Kim YC, Koester LA, Blanke KM. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976).2014;39(22):1899\u20131904.10.1097\/BRS.000000000000055625299168"},{"issue":"20","key":"b11","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2329","DOI":"10.1097\/01.brs.0000238968.82799.d9","article-title":"Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases","volume":"31","author":"Kim YJ","year":"2006","unstructured":"Kim YJ, Bridwell KH, Lenke LG, Rhim S, Cheh G. Pseudarthrosis in long adult spinal deformity instrumentation and fusion to the sacrum: prevalence and risk factor analysis of 144 cases. Spine (Phila Pa 1976).2006;31(20):2329\u20132336.10.1097\/01.brs.0000238968.82799.d9"},{"issue":"9","key":"b12","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/BRS.0b013e31827ae242","article-title":"Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery","volume":"38","author":"Hart RA","year":"2013","unstructured":"Hart RA, Cabalo A, Bess S, Akbarnia BA, Boachie-Adjei O, Burton D,  Comparison of patient and surgeon perceptions of adverse events after adult spinal deformity surgery. Spine (Phila Pa 1976).2013;38(9):732\u2013736.10.1097\/BRS.0b013e31827ae24224477053"},{"issue":"4","key":"b13","series-title":"Oper Neurosurg (Hagerstown)","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1093\/ons\/opx151","article-title":"A novel 4-rod technique offers potential to reduce rod breakage and pseudarthrosis in pedicle subtraction osteotomies for adult spinal deformity correction","volume":"14","author":"Gupta S","year":"2018","unstructured":"Gupta S, Eksi MS, Ames CP, Deviren V, Durbin-Johnson B, Smith JS, Gupta MC. A novel 4-rod technique offers potential to reduce rod breakage and pseudarthrosis in pedicle subtraction osteotomies for adult spinal deformity correction. Oper Neurosurg (Hagerstown). 2018;14(4):449\u2013456.10.1093\/ons\/opx15128973658"},{"issue":"1","key":"b14","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1227\/NEU.0b013e31820f362a","article-title":"Biomechanical analysis of revision strategies for rod fracture in pedicle subtraction osteotomy","volume":"69","author":"Scheer JK","year":"2011","unstructured":"Scheer JK, Tang JA, Deviren V, Buckley JM, Pekmezci M, McClellan RT, Ames CP. Biomechanical analysis of revision strategies for rod fracture in pedicle subtraction osteotomy. Neurosurgery. 2011;69(1):164\u20131722.2133621810.1227\/NEU.0b013e31820f362a"},{"issue":"6","key":"b15","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/j.spinee.2019.01.005","article-title":"Supplemental rods are needed to maximally reduce rod strain across the lumbosacral junction with TLIF but not ALIF in long constructs","volume":"19","author":"Godzik J","year":"2019","unstructured":"Godzik J, Hlubek RJ, Newcomb AGUS, Lehrman JN, de Andrada Pereira B, Farber SH,  Supplemental rods are needed to maximally reduce rod strain across the lumbosacral junction with TLIF but not ALIF in long constructs. Spine J. 2019;19(6):1121\u20131131.10.1016\/j.spinee.2019.01.005"},{"issue":"7","key":"b16","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E388","DOI":"10.1097\/BRS.0000000000001282","article-title":"Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study","volume":"41","author":"Hallager DW","year":"2016","unstructured":"Hallager DW, Gehrchen M, Dahl B, Harris JA, Gudipally M, Jenkins S,  Use of supplemental short pre-contoured accessory rods and cobalt chrome alloy posterior rods reduces primary rod strain and range of motion across the pedicle subtraction osteotomy level: an in vitro biomechanical study. Spine (Phila Pa 1976).2016;41(7):E388\u2013E395.10.1097\/BRS.0000000000001282"},{"issue":"3","key":"b17","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1007\/s00586-016-4859-8","article-title":"Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs","volume":"26","author":"Luca A","year":"2017","unstructured":"Luca A, Ottardi C, Sasso M, Prosdocimo L, La Barbera L, Brayda-Bruno M,  Instrumentation failure following pedicle subtraction osteotomy: the role of rod material, diameter, and multi-rod constructs. Eur Spine J. 2017;26(3):764\u2013770.2785823810.1007\/s00586-016-4859-8"},{"issue":"9","key":"b18","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s00586-018-5623-z","article-title":"Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy","volume":"27","author":"La Barbera L","year":"2018","unstructured":"La Barbera L, Brayda-Bruno M, Liebsch C, Villa T, Luca A, Galbusera F, Wilke HJ. Biomechanical advantages of supplemental accessory and satellite rods with and without interbody cages implantation for the stabilization of pedicle subtraction osteotomy. Eur Spine J. 2018;27(9):2357\u20132366.10.1007\/s00586-018-5623-z"},{"issue":"6","key":"b19","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1177\/2192568217699392","article-title":"Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity","volume":"7","author":"Merrill RK","year":"2017","unstructured":"Merrill RK, Kim JS, Leven DM, Kim JH, Cho SK. Multi-rod constructs can prevent rod breakage and pseudarthrosis at the lumbosacral junction in adult spinal deformity. Global Spine J. 2017;7(6):514\u2013520.2889468010.1177\/2192568217699392"},{"issue":"1","key":"b20","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"103","DOI":"10.3171\/2020.6.SPINE20678","article-title":"Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study","volume":"34","author":"El Dafrawy MH","year":"2021","unstructured":"El Dafrawy MH, Adogwa O, Wegner AM, Pallotta NA, Kelly MP, Kebaish KM,  Comprehensive classification system for multirod constructs across three-column osteotomies: a reliability study. J Neurosurg Spine. 2021;34(1):103\u2013109.10.3171\/2020.6.SPINE20678"},{"issue":"6","key":"b21","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"E312","DOI":"10.1097\/BRS.0000000000003269","article-title":"Mechanical analysis of notch-free pre-bent rods for spinal deformity surgery","volume":"45","author":"Yamada K","year":"2020","unstructured":"Yamada K, Sudo H, Iwasaki N, Chiba A. Mechanical analysis of notch-free pre-bent rods for spinal deformity surgery. Spine (Phila Pa 1976).2020;45(6):E312\u2013E318.10.1097\/BRS.000000000000326931574057"},{"issue":"3","key":"b22","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.spinee.2017.08.235","article-title":"Use of the \u201cdual construct\u201d for the management of complex spinal reconstructions","volume":"18","author":"Shen FH","year":"2018","unstructured":"Shen FH, Qureshi R, Tyger R, Lehman R, Singla A, Shimer A, Hassanzadeh H. Use of the \u201cdual construct\u201d for the management of complex spinal reconstructions. Spine J. 2018;18(3):482\u2013490.2888727310.1016\/j.spinee.2017.08.235"},{"issue":"2","key":"b23","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1227\/NEU.0b013e31827ba066","article-title":"Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study","volume":"72","author":"Tang JA","year":"2013","unstructured":"Tang JA, Leasure JM, Smith JS, Buckley JM, Kondrashov D, Ames CP. Effect of severity of rod contour on posterior rod failure in the setting of lumbar pedicle subtraction osteotomy (PSO): a biomechanical study. Neurosurgery. 2013;72(2):276\u201383.2314995610.1227\/NEU.0b013e31827ba066"},{"issue":"9","key":"b24","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.1007\/s00586-019-06012-2","article-title":"Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study","volume":"28","author":"Berjano P","year":"2019","unstructured":"Berjano P, Xu M, Damilano M, Scholl T, Lamartina C, Jekir M, Galbusera F. Supplementary delta-rod configurations provide superior stiffness and reduced rod stress compared to traditional multiple-rod configurations after pedicle subtraction osteotomy: a finite element study. Eur Spine J. 2019;28(9):2198\u20132207.3112976310.1007\/s00586-019-06012-2"},{"key":"b25","series-title":"Surg Neurol Int","doi-asserted-by":"publisher","first-page":"207","DOI":"10.4103\/sni.sni_44_17","article-title":"Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: a finite element study","volume":"8","author":"Januszewski J","year":"2017","unstructured":"Januszewski J, Beckman JM, Harris JE, Turner AW, Yen CP, Uribe JS. Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: a finite element study. Surg Neurol Int. 2017;8:207.2896681410.4103\/sni.sni_44_17"},{"issue":"1)(suppl 1","key":"b26","series-title":"Eur Spine J","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1007\/s00586-019-06283-9","article-title":"Revision strategies for failed adult spinal deformity surgery","volume":"29","author":"Martini C","year":"2020","unstructured":"Martini C, Langella F, Mazzucchelli L, Lamartina C. Revision strategies for failed adult spinal deformity surgery. Eur Spine J. 2020;29(1)(suppl 1):116\u2013125.3192762310.1007\/s00586-019-06283-9"},{"issue":"3","key":"b27","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"415","DOI":"10.3171\/2019.9.SPINE19389","article-title":"The \u201ckickstand rod\u201d technique for correction of coronal imbalance in patients with adult spinal deformity: initial case series","volume":"32","author":"Makhni MC","year":"2020","unstructured":"Makhni MC, Zhang Y, Park PJ, Cerpa M, Yang M, Pham MH,  The \u201ckickstand rod\u201d technique for correction of coronal imbalance in patients with adult spinal deformity: initial case series. J Neurosurg Spine. 2020;32(3):415\u2013422.3178335110.3171\/2019.9.SPINE19389"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/36\/6\/article-p1023.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/36\/6\/article-p1023.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/36\/6\/article-p1023.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T20:56:24Z","timestamp":1751057784000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/36\/6\/article-p1023.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,1]]},"references-count":27,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.3171\/2021.10.spine21745","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2022,6,1]]}}}