• Ki Young Lee, Jung-Hee Lee, Kyung-Chung Kang, and Cheol Hyun Jung.
• Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea.
• Spine. 2024 Sep 15; 49 (18): E291E299E291-E299.

Study DesignA retrospective study.ObjectivesTo analyze factors associated with rod fracture (RF) in adult spinal deformity (ASD), and to assess whether the accessory rod (AR) technique can reduce RF occurrence in deformity correction in the setting of minimally invasive lateral lumbar interbody fusion (LLIF).Summary Of Background DataInstrumentation failure is the most common reason for revision surgery in ASD. Several RF reduction methods have been introduced. However, there are insufficient studies on postoperative RF after deformity correction using minimally invasive LLIF.Materials And MethodsThis study included 239 patients (average age 71.4 y and a minimum 2-year follow-up) with ASD who underwent long-segment fusion from T10 to sacrum with sacropelvic fixation. Patients were classified into the non-RF group and the RF group. After logistic regression analysis of the risk factors for RF, subgroup analyses were performed: pedicle subtraction osteotomy (PSO) with two-rod (P2 group) versus PSO with two-rod and AR (P4 group), and LLIF with two-rod (L2 group) versus LLIF with two-rod and AR (L4 group).ResultsRF occurred in 50 patients (21%) at an average of 25 months. RF occurred more frequently in patients who underwent PSO than in those who underwent LLIF ( P =0.002), and the use of the AR technique was significantly higher in the non-RF group ( P <0.05).Following logistic regression analysis, preoperative PI-LL mismatch, PSO, and the AR technique were associated with RF. In subgroup analyses, RF incidence was 65% (24/37 cases) of the P2 group, 8% (4/51 cases) of the P4 group, and 21% (22/105 cases) of the L2 group. In the L4 group, there was no RF.ConclusionMinimally invasive multilevel LLIF with the AR technique is capable of as much LL correction as conventional PSO and appears to be an effective method for reducing RF.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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