• Anouar Bourghli, Louis Boissiere, Derek Cawley, Daniel Larrieu, Javier Pizones, Ahmet Alanay, Ferran PelIise, Franck Kleinstück, Ibrahim Obeid, and European Spine Study Group.
• Orthopedic and Spinal Surgery Department, Kingdom Hospital, P.O.Box 84400, Riyadh, 11671, Saudi Arabia. Anouar.bourghli@gmail.com.
• Eur Spine J. 2022 Sep 1; 31 (9): 2408-2414.

PurposeTo compare the radiological outcomes and complications of adult spinal deformity patients who underwent a pedicle subtraction osteotomy (PSO) below L2 but categorized according to their construct where either a domino connector was applied for osteotomy correction or not.MethodsRetrospective review of a prospective, multicenter adult spinal deformity database (5 sites). Inclusion criteria were adult patients who underwent PSO between L3 and L5 with a minimum follow-up of 2 years. Among 1243 patients in the database, 79 met the inclusion criteria, 41 in the no-domino (ND) group and 38 in the domino (D) group. The domino technique consisted of using 2 parallel rods connected by a domino on one side of the PSO in order to achieve gradual and controlled compression at the osteotomy site. Demographic data, operative parameters, spinopelvic parameters and complications were collected.ResultsDemographic data and operative parameters were globally similar between both groups, and they showed a comparable preoperative sagittal malalignment. Segmental lordosis improved by 22° and 31° (p < 0.05) and L1S1 lordosis improved by 23° and 32° (p < 0.05) in the ND and D group, respectively. The use of multiple rods was similar between the groups (58% vs. 57%). Also, mechanical complications rate was globally similar between both groups with no statistically significant difference (22% vs. 28.9%).ConclusionDomino connector is a safe, powerful and efficient tool for pedicle subtraction osteotomy site closure. It improved the lumbar lordosis correction angle with an acceptable rate of complications.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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