Use of the “dual construct” for the management of complex spinal reconstructions

Publication date: Available online 5 September 2017
Source:The Spine Journal
Author(s): Francis H. Shen, Rabia Qureshi, Rose Tyger, Rebecca Lehman, Anuj Singla, Adam Shimer, Hamid Hassanzadeh
Background ContextSurgical management of complex spinal reconstructions remains a clinical challenge, as pseudoarthrosis with subsequent rod breakage can occur. Increased rod density in the form of "satellite" or "outrigger" rods have been described; however rod-fracture above or below satellite rods persist and can result in dissociation of the construct, loss of correction, and recurrence of deformity. The use of four distinct and mechanically independent rods (Dual Construct) reduces this concern. Since the original case description in 2006, there have been no other studies that utilize the Dual Construct for the surgical management of complex spinal reconstructions.PurposeThe purpose of this study is to review the long-term experience and surgical technique utilizing the Dual Construct, and to present our complications, rod fracture rates, and outcomes for the surgical management of complex spinal reconstructions.Study DesignTechnique with Case Series OutcomesPatient SamplePatients from single-institute undergoing Dual Construct, 2010-2014 available for 2 year follow-upOutcomes MeasuredRadiographic and functional outcomes, complications, rod fracture rates and revision surgery ratesMethodsRetrospective review was conducted from a single institution between period of 2010 and 2014 with a subsequent 2-year follow-up period. Extensive review of patients' medical record, radiographs, and advanced imaging where available was performed. Medical record was evaluated for patient demographics, surgical procedure, and complications. Radiographic measurements included presence or absence of implant failure and proximal junctional kyphosis/distal junctional kyphosis.ResultsA total of 36 patients underwent surgical reconstruction. The average estimated blood loss was 1,856 cc (range, 400 – 4,000 cc). The average length of stay was 7.3 days (range, 4 – 22 days).Clinical follow-up reported 21 patients (58.3%) with no or minimal pain. There were 6 deaths during the follow-up unrelated to the index procedure. Radiographic follow-up revealed 3 patients (8.3%) with rod fracture; 1 patient with 1 rod fracture, and 2 patients with 2 rod fracture. No patients had 3 or all 4 rods fractures. There were no screw fractures. None of the patients with rod fractures required revision surgery.ConclusionsThe biggest advantage of the Dual Construct is that rod breakage, although uncommon, is typically minimal, or asymptomatic, and more importantly does not result in loss of alignment, and therefore has not required revision surgery. The Dual Construct approach is a safe alternative to traditional 2-rod constructs, with encouraging outcomes at follow-up.



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