title: Outrigger rod technique for supplemental support of posterior spinal arthrodesis.
abstract: BACKGROUND
  Instrumentation failure is a recognized complication after complex spinal reconstruction and deformity correction. Rod fracture (RF) is the most frequent mode of hardware failure in long-segment spinal fusion surgery. This complication can negatively impact the clinical outcome by producing spinal pain, functional compromise, instability, and loss of deformity correction.
  
  
  OBJECTIVE
  To describe the outrigger rod surgical technique.
  
  
  METHODS
  Review of literature, case review, and surgical technique description.
  
  
  METHODS
  Two clinical cases are presented.
  
  
  METHODS
  Rod fracture.
  
  
  METHODS
  Outrigger rod placement in posterior spinal arthrodesis is performed by supplementing primary spinal rods with outrigger rods attached with cranial and caudal side-by-side connectors providing a more robust construct.
  
  
  RESULTS
  This technique may be beneficial for preventing RF in patients undergoing surgery for three-column osteotomy for sagittal imbalance; pseudarthrosis surgery with previous hardware failure; transforaminal lumbar interbody cage placement at multiple levels in realignment procedures, long-segment spinal arthrodesis with impaired host fusion potential; long-segment instrumented fusions that span the cervicothoracic, thoracolumbar, or lumbosacral junction; and across spinal segments at high risk for RF (eg, after extensive resection of vertebral elements in the management of metastatic malignancy).
  
  
  CONCLUSIONS
  The risk of rod failure is substantial in the setting of long-segment spinal arthrodesis and corrective osteotomy. Efforts to increase the mechanical strength of posterior constructs may reduce the occurrence of this complication. The outrigger rod technique increases spinal construct stiffness and may improve the longevity of the construct. This technique should reduce the rate of device failure during maturation of posterior fusion mass and limit the need for supplemental anterior column support.
authors.affiliation: Department of Orthopedic Surgery, Alpert Medical School of Brown University, 2 Dudley St, Providence, RI 02905, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Palumbo
authors.affiliation: Department of Orthopedic Surgery, Alpert Medical School of Brown University, 2 Dudley St, Providence, RI 02905, USA.
authors.forename: Kalpit N
authors.initials: KN
authors.lastname: Shah
authors.affiliation: Department of Orthopedic Surgery, Alpert Medical School of Brown University, 2 Dudley St, Providence, RI 02905, USA.
authors.forename: Craig P
authors.initials: CP
authors.lastname: Eberson
authors.affiliation: 593 Eddy St, Providence, RI 02903, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Department of Orthopedic Surgery, Alpert Medical School of Brown University, 2 Dudley St, Providence, RI 02905, USA. Electronic address: alandanielsmd@gmail.com.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D012600:Scoliosis / Q000601:surgery; D016103:Spinal Fractures / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: Instrumentation failure; Long-segment fusion; Ourigger rod; Revision surgery; Rod fracture (RF); Spinal deformity