• Young-Hoon Kim, Kee-Yong Ha, Hyung-Youl Park, Joon-Soo Ihm, and Sang-Il Kim.
• Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
• World Neurosurg. 2022 Sep 1; 165: e643e649e643-e649.

ObjectiveThe objective of this study was to investigate the incidence and risk factors of rod fractures (RFs) after a single-level lumbar pedicle subtraction osteotomy (PSO) using a side-tightening (ST) pedicle screw system.MethodsFifty-seven consecutive patients who underwent a single-level lumbar PSO for the degenerative sagittal imbalance at a single institution were retrospectively reviewed. All surgeries were performed by a single surgeon using an ST pedicle screw system. Demographic, surgical, and radiographic data were analyzed to investigate the incidence and risk factors for RF.ResultsSeven (12.3%) patients showed RF after PSO. Four patients had bilateral RFs, and 3 patients had unilateral RFs. The location of the RF was at the PSO level in 6 of 7 patients. The ratio of adjacent interbody fusion was significantly different between the group with RF and the group without RF (16.7% vs. 74.0%, P = 0.004). The preoperative segmental angle at the PSO vertebra (-6.1° ± 5.5° vs. -1.7° ± 4.6°, P = 0.049) and postsurgical change in lumbar lordosis (48.4° ± 8.8° vs. 37.8° ± 11.9°, P = 0.033) were significantly different between the 2 groups. Risk factor analysis using stepwise logistic regression analysis revealed that the absence of an adjacent interbody cage (odds ratio = 0.011, 95% confidence interval = 0.000-0.390, P = 0.013) was a significant risk factor.ConclusionsThe incidence of RF after a single-level lumbar PSO using the ST pedicle screw system was 12.3% in our cohort. The absence of an adjacent interbody cage was a significant risk factor for RF.Copyright © 2022 Elsevier Inc. All rights reserved.

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