efficacy and safety of the kickstand rod technique for coronal malalignment correction in adult spinal deformity: a systematic review and meta-analysis

Adult spinal deformity (asd) affects up to 68% of older adults and is associated with high complication and reoperation rates despite current treatments. the kickstand rod (ksr) technique has been used to improve coronal malalignment with varying outcomes. this meta-analysis evaluates the efficacy and safety of the ksr technique in asd correction. a systematic search of five electronic databases identified studies on asd patients undergoing surgery with the ksr technique. efficacy outcomes, including coronal malalignment, sagittal imbalance, and lumbar lordosis, were analyzed using weighted mean difference under the der-simonian laird random-effects model. safety outcomes were assessed through a single-arm meta-analysis estimating the pooled prevalence of adverse events. the ksr technique demonstrated a clinically meaningful improvement in coronal malalignment, with a mean correction of 52.19 mm (95% ci: 38.90-65.49), which exceeds the commonly accepted threshold for functional improvement in adult spinal deformity patients, mean change: 52.19 mm; 95% ci: 38.90–65.49; p < 0.001), sagittal imbalance (mean change: 58.61 mm; 95% ci: 38.66-78.57; p < 0.001), and lumbar lordosis (mean change: -16.21°; 95% ci: -22.53 to -9.89; p < 0.001). the pooled prevalence of wound complications was 8% (95% ci: 4-16%), while the need for revision surgery was 15% (95% ci: 10-20%). the ksr technique is an effective and safe method for correcting coronal malalignment in asd. further research is needed to refine the technique and reduce adverse effects.