Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system

Background: Surgical management of complex spine disorders with instrumentation continues to expand. This present study investigates the possible therapeutic uses of a categorization nomenclature system that is widely recognized for multiple-rod constructs in spine reconstruction surgery utilizing a...

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Main Authors: Periklis Godolias, Clifford Pierre, Zachary Tataryn, Matias Costa, Nathan Pratt, Jerry Robinson, Yevgeniy Freyvert, Jared Cooke, Ryan Goodmanson, Joseph Detorri, Hamzah Al-awadi, Rod J. Oskouian, Jens R. Chapman, Benjamin A. Schell
Format: Article
Language:English
Published: Elsevier 2025-04-01
Series:World Neurosurgery: X
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Online Access:http://www.sciencedirect.com/science/article/pii/S2590139725000225
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author Periklis Godolias
Clifford Pierre
Zachary Tataryn
Matias Costa
Nathan Pratt
Jerry Robinson
Yevgeniy Freyvert
Jared Cooke
Ryan Goodmanson
Joseph Detorri
Hamzah Al-awadi
Rod J. Oskouian
Jens R. Chapman
Benjamin A. Schell
author_facet Periklis Godolias
Clifford Pierre
Zachary Tataryn
Matias Costa
Nathan Pratt
Jerry Robinson
Yevgeniy Freyvert
Jared Cooke
Ryan Goodmanson
Joseph Detorri
Hamzah Al-awadi
Rod J. Oskouian
Jens R. Chapman
Benjamin A. Schell
author_sort Periklis Godolias
collection DOAJ
description Background: Surgical management of complex spine disorders with instrumentation continues to expand. This present study investigates the possible therapeutic uses of a categorization nomenclature system that is widely recognized for multiple-rod constructs in spine reconstruction surgery utilizing a modified Delphi technique. Methods: An extensive literature review identified articles on multiple-rod constructs where definitions and names of multiple-rod constructs were categorized according to inclusion criteria. An expert panel of spine surgeons using a modified Delphi process established the framework of terms for the multiple-rod scheme for the classification of heterogeneous rods for multiple etiologies (CHRoME). Four key questions based on a review of spinal x-ray films and relevant clinical indications were used to create CHRoME: number of rods present, extension of the rostral construct, purpose of the working rod, and number of screws for pelvic fixation. Next the CHRoME score was used by a panel of spine surgeons to evaluate images from a sample of 10 case scenarios. Results: Our expert panel were able to classify images with very good agreement and high rates of inter-rater reliability (kappa coefficient 0.83; 95 % CI: 0.69–0.96). With a kappa coefficient of 0.94 (95 percent CI, 0.90 to 0.99), the intra-rater reliability was almost flawless. Conclusions: The novel classification of heterogeneous rods for multiple etiologies (CHRoME) score, based on 4 essential questions, is used to define multiple-rod constructs and gives a consistent description of the numerous ways that instrumentation is used in spine surgery.
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spelling doaj-art-2a77152458da482eb2805dcc82f072ce2025-08-20T03:52:24ZengElsevierWorld Neurosurgery: X2590-13972025-04-012610044810.1016/j.wnsx.2025.100448Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring systemPeriklis Godolias0Clifford Pierre1Zachary Tataryn2Matias Costa3Nathan Pratt4Jerry Robinson5Yevgeniy Freyvert6Jared Cooke7Ryan Goodmanson8Joseph Detorri9Hamzah Al-awadi10Rod J. Oskouian11Jens R. Chapman12Benjamin A. Schell13Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany; Department of Orthopedics and Trauma Surgery, St. Josef Hospital Essen-Werden, Propsteistrasse 2, 45239, Essen, GermanySwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United States; Corresponding author. Seattle Science Foundation, 550 17th Avenue, Suite 600, Seattle, WA, 98122, , United States.clifford.pierre@gmail.comSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSpectrum Research, Inc., Steilacoom, WA, United StatesSeattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United StatesSwedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States; Seattle Science Foundation, Seattle, WA, United StatesBackground: Surgical management of complex spine disorders with instrumentation continues to expand. This present study investigates the possible therapeutic uses of a categorization nomenclature system that is widely recognized for multiple-rod constructs in spine reconstruction surgery utilizing a modified Delphi technique. Methods: An extensive literature review identified articles on multiple-rod constructs where definitions and names of multiple-rod constructs were categorized according to inclusion criteria. An expert panel of spine surgeons using a modified Delphi process established the framework of terms for the multiple-rod scheme for the classification of heterogeneous rods for multiple etiologies (CHRoME). Four key questions based on a review of spinal x-ray films and relevant clinical indications were used to create CHRoME: number of rods present, extension of the rostral construct, purpose of the working rod, and number of screws for pelvic fixation. Next the CHRoME score was used by a panel of spine surgeons to evaluate images from a sample of 10 case scenarios. Results: Our expert panel were able to classify images with very good agreement and high rates of inter-rater reliability (kappa coefficient 0.83; 95 % CI: 0.69–0.96). With a kappa coefficient of 0.94 (95 percent CI, 0.90 to 0.99), the intra-rater reliability was almost flawless. Conclusions: The novel classification of heterogeneous rods for multiple etiologies (CHRoME) score, based on 4 essential questions, is used to define multiple-rod constructs and gives a consistent description of the numerous ways that instrumentation is used in spine surgery.http://www.sciencedirect.com/science/article/pii/S2590139725000225Multiple rod constructsClassification systemAdult spinal deformitySpinal instrumentation
spellingShingle Periklis Godolias
Clifford Pierre
Zachary Tataryn
Matias Costa
Nathan Pratt
Jerry Robinson
Yevgeniy Freyvert
Jared Cooke
Ryan Goodmanson
Joseph Detorri
Hamzah Al-awadi
Rod J. Oskouian
Jens R. Chapman
Benjamin A. Schell
Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
World Neurosurgery: X
Multiple rod constructs
Classification system
Adult spinal deformity
Spinal instrumentation
title Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
title_full Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
title_fullStr Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
title_full_unstemmed Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
title_short Multiple-rod constructs in thoracolumbar reconstructive spine surgery: Building a novel classification of heterogeneous rods for multiple etiologies (CHRoME) scoring system
title_sort multiple rod constructs in thoracolumbar reconstructive spine surgery building a novel classification of heterogeneous rods for multiple etiologies chrome scoring system
topic Multiple rod constructs
Classification system
Adult spinal deformity
Spinal instrumentation
url http://www.sciencedirect.com/science/article/pii/S2590139725000225
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