{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T19:48:06Z","timestamp":1776282486675,"version":"3.50.1"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Primary rod fracture after surgery for adult spinal deformity (ASD) is a leading cause of revision, with recent prospective multicenter fracture rates reported at 11%\u201314% by 2 years. Consequently, the addition of supplemental rods has been explored to reduce fractures. Here the authors describe their experience with a novel iliac accessory rod technique in which each accessory rod anchors to an independent iliac bolt caudally via lateral connector, and attaches to the primary rod rostrally via side-to-side connector.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective, single-center case series included patients who underwent thoracolumbar\/lumbar fusion for ASD between March 2019 and August 2023. Data on baseline demographics, radiographic parameters, surgical characteristics, complications, rod fracture, and revision rates were collected. Paired, 2-tailed t-tests were used to compare pre- and postoperative radiographic outcomes. Rod fracture rates were compared to prior investigations via chi-square goodness of fit testing. The technique for iliac accessory rod placement is described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study consisted of 82 patients (mean age 66 years, 51% female, 26% with prior fusion) with a median follow-up of 2 years (IQR 28\u2013104 weeks). A total of 50 patients (61%) had \u2265 2-year follow-up. Each surgery involved an average of 4 posterior column osteotomies and 8 segments. Iliac accessory rods were cobalt chromium and were placed bilaterally in 87% of constructs. Postoperative alignment improved significantly in the following parameters: maximum coronal Cobb angle, fractional curve, sagittal vertical axis, lumbar lordosis, thoracic kyphosis, and pelvic incidence to lumbar lordosis mismatch (p &lt; 0.001 for all comparisons). Of 50 patients with \u2265 2-year follow-up, rod fracture occurred in 1 (2.0%), which was incidentally found and required no intervention. The present rod fracture rate was significantly lower than the authors\u2019 historically reported institutional rate of 21% for traditional dual-rod constructs, and the 11%\u201314% reported in recent prospective multicenter studies that used traditional and supplemental rod constructs (p &lt; 0.05 for all comparisons). Reoperation occurred in 12 patients (14.6%); 7 (8.5%) for proximal junctional kyphosis and 5 (6.1%) for wound complication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Here the authors describe their experience with a novel iliac accessory rod technique to prevent rod fracture in patients undergoing surgery for ASD. The 2-year rod fracture rate (2.0%) in this study is significantly lower than the authors\u2019 historical dual-rod fracture rate, and other prospective multicenter investigations. Future studies with longer follow-up are needed to determine the durability of this technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.5.spine24208","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T21:53:55Z","timestamp":1722030835000},"page":"424-432","source":"Crossref","is-referenced-by-count":5,"title":["Novel method of iliac accessory rods for rod fracture prevention in adult deformity surgery: a case series of 82 patients with outcomes and complications"],"prefix":"10.3171","volume":"43","author":[{"given":"Connor","family":"Berlin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Ben-Israel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P.","family":"Sardi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian J.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark E.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sufyan","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10193","key":"b1","series-title":"Lancet","first-page":"160","article-title":"Adult spinal deformity","volume":"394","author":"Diebo BG","year":"2019","unstructured":"Diebo BG, Shah NV, Boachie-Adjei O,  Adult spinal deformity. 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The lexicon of multirod constructs in adult spinal deformity: a concise description of when, why, and how. J Neurosurg Spine. 2021;36(6):1023\u20131029."},{"issue":"9","key":"b32","series-title":"Bone Joint J","first-page":"1227","article-title":"Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spinal osteotomy","volume":"98-B","author":"Bao H","year":"2016","unstructured":"Bao H, Yan P, Qiu Y, Liu Z, Zhu F. Coronal imbalance in degenerative lumbar scoliosis: prevalence and influence on surgical decision-making for spinal osteotomy. Bone Joint J. 2016;98-B(9):1227-1233."},{"issue":"1","key":"b33","series-title":"Eur Spine J","first-page":"94","article-title":"Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline","volume":"28","author":"Obeid I","year":"2019","unstructured":"Obeid I, Berjano P, Lamartina C, Chopin D, Boissi\u00e8re L, Bourghli A. 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J Neurosurg Spine. 2019;30(5):635\u2013643."},{"issue":"1","key":"b35","series-title":"Spine Deform","first-page":"231","article-title":"Rod fractures and nonunions after long fusion to the sacrum for primary presentation adult spinal deformity: a comparison with and without interbody fusion in the distal lumbar spine","volume":"9","author":"El Dafrawy M","year":"2021","unstructured":"El Dafrawy M, Bridwell K, Adogwa O,  Rod fractures and nonunions after long fusion to the sacrum for primary presentation adult spinal deformity: a comparison with and without interbody fusion in the distal lumbar spine. 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