{"id":4964,"date":"2015-12-16T00:00:00","date_gmt":"2015-12-16T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2015\/12\/16\/custom-rods-take-guesswork-out-of-spine-surgery\/"},"modified":"2025-03-03T09:25:06","modified_gmt":"2025-03-03T16:25:06","slug":"custom-rods-take-guesswork-out-of-spine-surgery","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/custom-rods-take-guesswork-out-of-spine-surgery\/","title":{"rendered":"Custom rods take guesswork out of spine surgery"},"content":{"rendered":"
<\/div>

The ghostly spine in the X-ray image looks like the track of a looping coaster at Elitch Gardens or a road Dr. Seuss might have sketched in one of his more fanciful moments. It belonged to a patient with severe scoliosis. Thanks to a new technology that\u2019s taken the most medieval \u2013 and, ultimately, most pivotal \u2013 minutes out of advanced reconstructive spine surgery, the patient\u2019s backbone is now a lot less contorted.<\/p>\n

It\u2019s also a lot more functional, said Evalina Burger, MD, the University of Colorado School of Medicine spine surgeon who, with colleague CJ Kleck, MD<\/a>, operated on the man a couple of months ago.<\/p>\n

UNiD rods in a UCH operating room.<\/figcaption><\/figure>\n

\u201cHe\u2019s able to walk,\u201d Burger said, considering the before-and-after X-rays on a screen in a busy nook of the Spine Center at University of Colorado Hospital. The success is the product of what might be considered an approach to personalized medicine.<\/p>\n

More than metal rods<\/strong><\/p>\n

The technology in question is a software package combined with a metallurgical service that yields a pair of roughly 16-inch-long titanium rods. Metal rods \u2013 technically speaking, spinal osteosynthesis rods \u2013 have been mainstays in spinal surgery for decades, to realign and support stenotic, kyphotic, scoliotic and other painful, debilitating conditions that affect spines.<\/p>\n

The metal rods can be short, supporting a couple of vertebra, or they can span much of the spine. So it is with Medicrea\u2019s UNiD patient-specific spine implant, the name for these particular metal rods. They are different than previous metal rods because spine surgeons needn\u2019t pause during a major, open surgery to play the role of metalworker. UCH is the only hospital in the region using them.<\/p>\n

Until November 2014, when the U.S. Food and Drug Administration approved the UNiD, osteosynthesis rods arrived in the OR arrow-straight. Then, in the operating room, with the patient open on the table, surgeons estimated the ideal shape of a matching pair of rods and then employed an instrument called a French bender to create a supportive shape.<\/p>\n

There were a couple of problems with this. First, having to bend rods during surgery prolongs OR time (and with it, risk of infection) by 30 minutes to an hour, Kleck estimates. Second, the French bender can only bend a rod so far, and some spines demand deeper rod-bends than the tool can deliver. Third, and most importantly, manually bending a rod sharply increases the chances that it will break. Burger, who has had a long-standing research interest in the metallurgy of spinal rods, explained it this way.<\/p>\n

Evalina Burger, MD, calls a new spinal implant a \u201ctemplate, a guide during surgery”.<\/figcaption><\/figure>\n

\u201cIf you bend any metal manually, you cause notching, which is metallurgically very important because it changes the characteristics of the titanium at that spot and makes it more fragile, so you get fretting and fragility fractures,\u201d she said.<\/p>\n

Real consequences<\/strong><\/p>\n

On a flat screen rotated vertically, Kleck pulled up a radiograph of a patient with a rod break. It had snapped at the deepest bend in the lumbar. A broken spinal rod like this requires a \u201crevision surgery,\u201d in this case not to fix the spinal problem, but rather a problem with the solution.<\/p>\n

\u201cWhen we pulled it out, the break was right where the notching was,\u201d Kleck said.<\/p>\n

Rod breaks are bad for patients and the health care system, and they have been happening a lot: in the United States, about 25 percent of the time, Burger said, though the UCH Spine Center\u2019s rate of 14 percent is a lot better.<\/p>\n

Burger\u2019s colleague, CJ Kleck, MD, says the new implant reduces the risk of a spinal rod breaking.<\/figcaption><\/figure>\n

They\u2019ve had no rod breaks since they started using the UNiD more than a year ago, she added. It\u2019s become the standard of care for complex spine corrections at UCH, with 40 surgeries complete or on the docket as of early December.<\/p>\n

Software called Surgimap<\/a> is the critical enabler. Burger and Kleck use it to digitally mark-up X-rays, calculating precisely what rod curvature is needed based on when the patient is in a natural, vertical position \u2013 as opposed to lying prone on an OR table, an orientation in which, as Burger put it \u201call the parameters change.\u201d They send the file off to Medicrea, where the French company manufactures a pair of rods to those exact specifications, returning it to UCH less than a week later.<\/p>\n

The UCH Spine Center was an early adopter of the UNiD, thanks to Burger\u2019s familiarity with Medicrea, with which she has had a consulting agreement. She said that, in addition to improved OR efficiencies and reduced risk of rod breakage, the system has \u201cmade a significant difference in what we plan and what we can more reliably achieve\u201d in surgery. The combination of morphological guesswork and metallurgical improvisation has, in the past, occasionally led to spinal fixes that left patients leaning one way or the other and requiring surgical adjustment after the fact, she added.<\/p>\n

\u201cIn the OR, it\u2019s much less stressful because you know where you\u2019re heading,\u201d Burger said.<\/p>\n

Now, rather than being a last-minute, high-risk variable, the rod is an extension of a well-mapped procedure.<\/p>\n

\u201cThe rod becomes a template, a guide during surgery,\u201d Burger said as she looked at another Seussian X-ray. \u201cIf you go to all that expense and time and resources and don\u2019t correct the patient, you don\u2019t gain anything.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

The ghostly spine in the X-ray image looks like the track of a looping coaster at Elitch Gardens or a road Dr. Seuss might have sketched in one of his more fanciful moments. It belonged to a patient with severe scoliosis. Thanks to a new technology that\u2019s taken the most medieval \u2013 and, ultimately, most […]<\/p>\n","protected":false},"author":23,"featured_media":2027,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[574,183,1242,442],"class_list":["post-4964","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-back-neck-and-spine-care","tag-orthopedics","tag-radiology","tag-spine-surgery"],"acf":[],"yoast_head":"\nCustom rods take guesswork out of spine surgery - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The ghostly spine in the X-ray image looks like the track of a looping coaster at Elitch Gardens or a road Dr. Seuss might have sketched in one of his more fanciful moments. 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