How good are we at rod bending?-a review of the literature and a case series of experienced pediatric and adult scoliosis surgeons.

Background: Manual contouring and insertion of spinal rods during corrective spinal fusion surgery are critical but challenging aspects that heavily rely on the surgeon's skill and experience. Variability in rod manipulation techniques can lead to prolonged surgery times, increased risks, and potential complications such as rod breakage or screw loosening. This case series reviews current literature and presents observational data on intraoperative rod manipulation across nine surgeries, providing insights that are crucial to improving surgical precision and outcomes. Case Description: The case series involves nine spinal surgery cases with patients ranging from pediatric to adult. Each case was observed for the number of rod bending and cutting maneuvers, time spent on these tasks, and the tools used. Results indicated that the total time spent on rod manipulation ranged up to 29 minutes, with 77.8% of cases requiring more than one attempt to achieve the correct rod length. Inefficiencies in rod length measurement and excessive bending attempts were commonly noted, leading to potential complications such as rod notching. The study concluded that these challenges significantly contribute to prolonged surgery times, increased risk of infection, and the potential for mechanical failure of the rods. By identifying specific areas of inefficiency and variability, this case series underscores the critical need for more standardized techniques and the development of more precise, easy-to-use tools that can improve surgical outcomes. Conclusions: This case series highlights significant variability and inefficiency in current spinal rod manipulation techniques, underscoring the need for standardized, precise methods that can reduce surgery time and improve patient outcomes. The findings provide a foundation for further research into simpler, more adaptable tools that could enhance the accuracy and efficiency of rod insertion in spinal surgeries.