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RCC (reinforced criss-cross construct): an easy and effective multi-rod thoraco-lumbar posterior reconstruction technique

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Spine Deformity Aims and scope Submit manuscript

Abstract

Study design

Surgical technical note and literature review.

Objectives

To describe a technique that uses 4 rod constructs in cases of complex thoracolumbar spinal deformity correction or revision surgeries based on the hybrid use of two different types of purchase points by a staggered pedicle screw fixation. It utilizes two rods on either side of the spine using a lateral and medial entry point of pedicle screws in the vertebral body.

Methods

Pedicle screws using extra-pedicular technique are more converging screws and are inserted alternately in the vertebral body and connected by rods. The left-out alternate vertebral bodies are fixed by a relatively straighter pedicle entry screw and connected to each other by a separate rod. So, two trajectories are independently used for a four-rod construct. This reconstruction has been named RCC (reinforced criss-cross construct). The screws in the index case were placed by free hand method, but we have increasingly utilized navigation guidance for placement of screws in recent times.

Results

We present a surgical technical note in a patient with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV-AIDS). He was diagnosed to have multi-drug-resistant (MDR) tuberculous spondylodiscitis, complicated with Immune reconstitution inflammatory syndrome (IRIS) and implant failure resulting in kyphosis and thoracic myelopathy. RCC with pharmacological management achieved healing and union, which was maintained at 4 years follow-up. Our method of four-rod construct provides a strong and lasting construct in the management of spinal deformities and three-column osteotomies. It provides good structural support to the spine till bony union is achieved.

Conclusion

Hybrid multi-rod construct like RCC provides a rigid mechanical support to the instrumentation and reduces the chances of rod failure especially in complex thoraco-lumbar spinal deformity correction surgeries.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Stavya Spine Hospital and Research Institute Pvt. Ltd, Mithakhali, Ahmedabad, Gujarat, India

    Ajay Krishnan, Aditya Raj, Umesh Meena, Devanand Degulmadi, Ravi Ranjan Rai, Shivanand Mayi, Mirant Dave & Bharat R. Dave

Authors
  1. Ajay Krishnan
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  2. Aditya Raj
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  3. Umesh Meena
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  4. Devanand Degulmadi
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  5. Ravi Ranjan Rai
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  6. Shivanand Mayi
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  7. Mirant Dave
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  8. Bharat R. Dave
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Contributions

Concept hypothesis: AK. Manuscript writing: AK, AR, SM, MD, BRD, UM, DD, RRR. Images/illustration making and editing: AR. Collection and assembly of data with analysis/interpretations: UM, DD, RRR. Revision: SM, MD, BRD, AK, UM, AR, DD, RR. Proof reading and final approval of manuscript: SM, MD, BRD, AK, UM, AR, DD, RR. Approval for investigation and doubt resolution: SM, MD, BRD, AK, UM, AR, DD, RRR.

Corresponding author

Correspondence to Ajay Krishnan.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Approval was obtained from the ethics committee of the Hospital where the study was conducted. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Informed consent was obtained from all individual participants included in the study. Patients signed informed consent regarding publishing their data and photographs.

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Krishnan, A., Raj, A., Meena, U. et al. RCC (reinforced criss-cross construct): an easy and effective multi-rod thoraco-lumbar posterior reconstruction technique. Spine Deform 10, 1203–1208 (2022). https://doi.org/10.1007/s43390-022-00504-w

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  • DOI: https://doi.org/10.1007/s43390-022-00504-w

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