• Yann Philippe Charles, François Severac, Susana Núñez-Pereira, Sleiman Haddad, Lluis Vila, Ferran Pellisé, Ibrahim Obeid, Louis Boissière, Caglar Yilgor, Altug Yucekul, Ahmet Alanay, Frank Kleinstück, Markus Loibl, Alejandro Gómez-Rice, Riccardo Raganato, Perez-GruesoFrancisco Javier SánchezFJSSpine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain., Javier Pizones, and European Spine Study Group (ESSG).
• Department of Spine Surgery, Strasbourg University Hospital, 1 Avenue Molière, 67200, Strasbourg, France. YannPhilippe.CHARLES@chru-strasbourg.fr.
• Eur Spine J. 2024 Dec 1; 33 (12): 464346524643-4652.

ObjectiveThe purpose was to analyze how rod characteristics, screw density and cages influence the incidence of mechanical complications compared to patient-related factors and alignment in adult spinal deformity instrumented T9-T11 to pelvis.MethodsRegister data of 302 patients was analyzed. Relative lumbar lordosis (RLL) and relative sagittal alignment (RSA) was measured. Surgical data included rod characteristics, pedicle screw density and interbody cages. Univariate and multivariate logistic regression models were used.ResultsPseudarthrosis occurred in 24.1%. On univariate analysis Odds Ratio (OR) was 0.74 for ≥ 3 cages (p = 0.452), 0.48 for 4 rods (p = 0.008), 4.30 for high screw density (p = 0.001). Patient-related factors were non-significant. Multivariate OR was 0.59 for 4 rods (p = 0.084) and 4.67 for high screw density (p = 0.005). PJK/PJF occurred in 19.2%. Age > 60 had an OR 2.83 (p = 0.023), postoperative RSA malaligned OR 2.84 (p = 0.030), severely malaligned OR 6.54 (p < 0.001). Implant characteristics were non-significant. Multivariate OR was 1.26 for age > 60 (p = 0.657), 2.32 for malaligned RSA (p = 0.097), 5.69 for severely malaligned RSA (p = 0.001). Screw loosening occurred in 8.9%. Univariate OR was 0.95 for ≥ 3 cages (p = 0.920), 1.64 for 4 rods (p = 0.235), 0.25 for high screw density 1.5-2 (p = 0.011). Patient-related factors were non-significant. Multivariate OR for high screw density was 0.23 (p = 0.022).ConclusionFour rods decrease the pseudarthrosis risk. Cages have a secondary role. High screw density doesn't prevent from pseudarthrosis. Postoperative malalignment is the main PJK/PJF risk factor. Age plays a secondary role. Implant characteristics have a minor influence. High screw density constructs have a lower risk for screw loosening.Level Of Evidence3-Retrospective register study.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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