Systematic review and meta-analysis for the impact of rod materials and sizes in the surgical treatment of adolescent idiopathic scoliosis

Purpose To assess surgical and safety outcomes associated with different rod materials and diameters in adolescent idiopathic scoliosis (AIS) surgery. Methods A systematic literature review and meta-analysis evaluated the surgical management of AIS patients using pedicle screw fixation systems (i.e., posterior rods and pedicle screws) with rods of different materials and sizes. Postoperative surgical outcomes (e.g., kyphosis and coronal correction) and complications (i.e., hyper/hypo-lumbar lordosis, proximal junctional kyphosis, revisions, reoperations, and infections) were assessed. Random-effects models (REMs) pooled data for outcomes reported in >= 2 studies. Results Among 75 studies evaluating AIS surgery using pedicle screw fixation systems, 46 described rod materials and/or diameters. Two studies directly comparing titanium (Ti) and cobalt-chromium (CoCr) rods found that CoCr rods provided significantly better postoperative kyphosis angle correction vs. Ti rods during a shorter follow-up (0-3 months, MD = - 2.98 degrees, 95% CI - 5.79 to - 0.17 degrees, p = 0.04), and longer follow-up (>= 24 months, MD = - 3.99 degrees, 95% CI - 6.98 to - 1.00, p = 0.009). Surgical infection varied from 2% (95% CI 1.0-3.0%) for 5.5 mm rods to 4% (95% CI 2.0-7.0%) for 6 mm rods. Reoperation rates were lower with 5.5 mm rods 1% (95% CI 0.0-3.0%) vs. 6 mm rods [6% (95% CI 2.0-9.0%); p = 0.04]. Differences in coronal angle, lumbar lordosis, proximal junctional kyphosis, revisions, and infections did not differ significantly (p > 0.05) among rods of different materials or diameters. Conclusion For AIS, CoCr rods provided better correction of thoracic kyphosis compared to Ti rods. Patients with 5.5 mm rods had fewer reoperations vs. 6.0 and 6.35 mm diameter rods.