Background:

To describe the use of intraoperative anteroposterior long cassette radiographs (APLCR) to guide kickstand rod application in adult spinal deformity.

Methods:

A retrospective chart review was performed to identify patients with adult thoracolumbar and coronal plane deformity undergoing open segmental decompression with spino-pelvic fixation and deformity correction between October 2017 and June 2019 had APLCR after rod placement. In patients with persistent intraoperative coronal deviations, a Kickstand rod was placed. This supplemental rod was anchored to an iliac screw and to the construct via a pair of side to side connectors. A distractor was expended between a vice grip plyer on the kickstand and side-to-side connector to apply a lateralizing force to reduce the degree of deviation.

Results:

A total of 15 patients underwent T3-Ilium fusion with spinal deformity correction with intraoperative APLCR; 7 underwent Kickstand placement. Mean preoperative coronal deviation was similar between cohorts (4.3 cm vs 2.2 cm, p = 0.09), but was greater intraoperatively in the kickstand cohort (4.3 cm vs 0.6 cm, 9 < 0.001). Postoperative coronal deviation was similar between groups (2.1cm vs 1.8cm, p = 0.37). Preoperative fractional lumbar curve was significantly greater in patients requiring kickstand (23˚ vs 35˚, p = 0.02), but major thoracolumbar curve was similar between groups (43˚ vs 35˚, p=0.14).

Conclusion:

Intraoperative APLCR can help guide application of kickstand in adult thoracolumbar deformity correction. Patients with a greater fractional lumbar curve may derive greater benefit of kickstand usage, independent of major curve magnitude.