Journal
OPERATIVE NEUROSURGERY
Volume 19, Issue 4, Pages 403-413Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ons/opaa073
Keywords
Adult spinal deformity; Coronal imbalance; Idiopathic scoliosis; Degenerative lumbar scoliosis; Scoliosis; Spine surgery; Surgical technique
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BACKGROUND: The kickstand rod technique has been recently described for achieving and maintaining coronal correction in adult spinal deformity (ASD). Kickstand rods span scoliotic lumbar spine from the thoracolumbar junction proximally to a kickstand iliac screw distally. Using the iliac wing as a base, kickstand distraction produces powerful corrective forces. Limited literature exists for this technique, and its associated outcomes and complications are unknown. OBJECTIVE: To assess alignment changes, early outcomes, and complications associated with kickstand rod distraction for ASD. METHODS: Consecutive ASD patients treated with kickstand distraction at our institution were retrospectively analyzed. RESULTS: The cohort comprised 19 patients (mean age: 67 yr; 79% women; 63% prior fusion) with mean follow-up 21 wk (range: 2-72 wk). All patients had posterior-only approach surgery with tri-iliac fixation (third iliac screw for the kickstand) for mean fusion length 12 levels. Three-column osteotomy and lumbar transforaminal lumbar interbody fusion were performed in 5 (26%) and 15 (79%) patients, respectively. Postoperative alignment improved significantly (corona) balance: 8 to 1 cm [P < .001]; major curve: 37 to 12 [P < .001]; fractional curve: 20 degrees to 10 degrees [P < .001]; sagittal balance: 11 to 4 cm [P < .001]; pelvic incidence to lumbar lordosis mismatch: 38 degrees to 9 degrees [P < .001]). Pain Numerical Rating Scale scores improved significantly (back: 7.2 to 4.2 [P = .001]; leg: 5.9 to 1.7 [P = .001]). No instrumentation complications occurred. Motor weakness persisted in 1 patient. There were 3 reoperations (1-PJK, 1-wound dehiscence, and 1-overcorrection). CONCLUSION: Among 19 ASD patients treated with kickstand rod distraction, alignment, and back/leg pain improved significantly following surgery. Complication rates were reasonable.
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