475 Molybdenum-Rhenium Rods in Complex Adult Spine Surgery Without Rod Fractures: A Multicenter Retrospective Case Series

INTRODUCTION: In complex spine surgery, current pedicle screw systems with 5.5 mm titanium, cobalt chromium or stainless steel rods have rod failure rates of approximately 9% with a minimum of 1-year follow-up. The fracture rate with these alloys increases to approximately 22% in PSO cases.1 Molybdenum-rhenium has demonstrated superior yield strength and fatigue endurance limit compared to Ti-6Al-4V and CoCr. METHODS: Retrospective, multicenter, case series. Inclusion criteria were = 4 levels posterior instrumented fusion with 4.5 mm molybdenum-rhenium rods, age = 18 yrs and 6 months or longer radiographic and followup. RESULTS: One hundred and fifty-nine (159) consecutive patients from ten different medical centers that had spinal surgery from August 2019 until April 2022 met inclusion criteria. Mean age was 63 ± 11.8 years; 50% women; 31% smokers; 19% diabetic and the mean BMI was 30 ± 7.3. The mean number of levels fused was 5.9 ± 2.7; 22.6% 4 levels, 64.2% 5-9 levels and 13.2% 10 levels or greater. Approximately half were thoracolumbar (27.7%) or thoracolumbar to pelvis (24.5%) and approximately half were lumbar-sacral (47.2%). Thirty-eight patients (24%) had a PSO and 59 patients (39%) had a SPO. All cases were done with molybdenum-rhenium 4.5 mm diameter rods. There were no RFs reported in the 159 cases (0/159; 0.0%) at 22.36 months mean follow-up. CONCLUSIONS: There was no incidence of RF in the 159 consecutive patients who underwent complex spine surgery involving multiple levels and osteotomies. A pedicle screw system based upon molybdenum-rhenium 4.5 mm rods provides superior fracture resistance particularly in complex spine procedures. 1 Smith JS, et al., Prospective multicenter assessment of risk factors for rod fracture following surgery for adult spinal deformity. J Neurosurg Spine. 2014 Dec; 21(6): 994-1003.