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Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video.

Abstract

Restoration of spinal alignment and balance is a major goal of adult scoliosis surgery. In the past, sagittal alignment has been emphasized and was shown to have the greatest impact on functional outcomes. However, recent evidence suggests the impact of coronal imbalance on pain and functional outcomes has likely been underestimated.1,2 In addition, iatrogenic coronal imbalance may be common and frequently results from inadequate correction of the lumbosacral fractional curve.2,3 The "kickstand rod" is a recently described technique to achieve and maintain significant coronal-plane correction.4 Also, of secondary benefit, the kickstand rod may function as an accessory supplemental rod to offload stress and bolster primary instrumentation. This may reduce occurrence of rod fracture (RF) or pseudarthrosis (PA).5 Briefly, this technique involves positioning the kickstand rod on the side of coronal imbalance (along the major curve concavity or fractional curve convexity in our video demonstration). The kickstand rod spans the thoracolumbar junction proximally to the pelvis distally and is secured with an additional iliac screw placed just superior to the primary iliac screw. By using the iliac wing as a base, powerful distraction forces can reduce the major curve to achieve more normal coronal balance. This operative video illustrates the technical nuances of utilizing the kickstand rod technique for correction of severe lumbar scoliosis and coronal malalignment in a 60-yr-old male patient. Alignment correction was achieved and maintained without evidence of RF/PA after nearly 6 mo postoperatively. The patient gave informed consent for surgery and to use imaging for medical publication.

Authors+Show Affiliations

Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.Department of Neurosurgery, University of Utah, Salt Lake City, Utah.Department of Neurosurgery, University at Buffalo, Buffalo, New York.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31584101

Citation

Buell, Thomas J., et al. "Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video." Operative Neurosurgery (Hagerstown, Md.), 2019.
Buell TJ, Buchholz AL, Mazur MD, et al. Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019.
Buell, T. J., Buchholz, A. L., Mazur, M. D., Mullin, J. P., Chen, C. J., Sokolowski, J. D., ... Smith, J. S. (2019). Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video. Operative Neurosurgery (Hagerstown, Md.), doi:10.1093/ons/opz306.
Buell TJ, et al. Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown). 2019 Oct 4; PubMed PMID: 31584101.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Kickstand Rod Technique for Correcting Coronal Imbalance in Adult Scoliosis: 2-Dimensional Operative Video. AU - Buell,Thomas J, AU - Buchholz,Avery L, AU - Mazur,Marcus D, AU - Mullin,Jeffrey P, AU - Chen,Ching-Jen, AU - Sokolowski,Jennifer D, AU - Yen,Chun-Po, AU - Shaffrey,Mark E, AU - Shaffrey,Christopher I, AU - Smith,Justin S, Y1 - 2019/10/04/ PY - 2018/12/24/received PY - 2019/07/15/accepted PY - 2019/10/5/entrez KW - Adult spinal deformity KW - Coronal imbalance KW - Degenerative scoliosis KW - Pseudarthrosis KW - Rod fracture KW - Scoliosis KW - Spine surgery KW - Surgical technique JF - Operative neurosurgery (Hagerstown, Md.) JO - Oper Neurosurg (Hagerstown) N2 - Restoration of spinal alignment and balance is a major goal of adult scoliosis surgery. In the past, sagittal alignment has been emphasized and was shown to have the greatest impact on functional outcomes. However, recent evidence suggests the impact of coronal imbalance on pain and functional outcomes has likely been underestimated.1,2 In addition, iatrogenic coronal imbalance may be common and frequently results from inadequate correction of the lumbosacral fractional curve.2,3 The "kickstand rod" is a recently described technique to achieve and maintain significant coronal-plane correction.4 Also, of secondary benefit, the kickstand rod may function as an accessory supplemental rod to offload stress and bolster primary instrumentation. This may reduce occurrence of rod fracture (RF) or pseudarthrosis (PA).5 Briefly, this technique involves positioning the kickstand rod on the side of coronal imbalance (along the major curve concavity or fractional curve convexity in our video demonstration). The kickstand rod spans the thoracolumbar junction proximally to the pelvis distally and is secured with an additional iliac screw placed just superior to the primary iliac screw. By using the iliac wing as a base, powerful distraction forces can reduce the major curve to achieve more normal coronal balance. This operative video illustrates the technical nuances of utilizing the kickstand rod technique for correction of severe lumbar scoliosis and coronal malalignment in a 60-yr-old male patient. Alignment correction was achieved and maintained without evidence of RF/PA after nearly 6 mo postoperatively. The patient gave informed consent for surgery and to use imaging for medical publication. SN - 2332-4260 UR - https://www.unboundmedicine.com/medline/citation/31584101/Kickstand_Rod_Technique_for_Correcting_Coronal_Imbalance_in_Adult_Scoliosis:_2-Dimensional_Operative_Video L2 - https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opz306 DB - PRIME DP - Unbound Medicine ER -