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Preoperative MRI and Intraoperative Monitoring Differentially Prevent Neurological Sequelae in Idiopathic Scoliosis Surgical Correction, While Curves >70 Degrees Increase the Risk of Neurophysiological Incidences. J Clin Med 2022; 11:jcm11092602. [PMID: 35566726 PMCID: PMC9104016 DOI: 10.3390/jcm11092602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 01/27/2023] Open
Abstract
The aim was to investigate the role of preoperative magnetic resonance imaging (MRI) and intraoperative monitoring (IOM) in the prevention of correction-related complications in idiopathic scoliosis (IS). We conducted a retrospective case study of 129 patients with juvenile and adolescent IS. The operations took place between 2005 and 2018 in Uppsala University Hospital. Data from MRI scans and IOM were collected. The patients were divided into groups depending on Lenke’s classification, sex, major curve (MC) size, and onset age. Neurophysiological incidences were reported in ten patients (7.8%), while nine of them had no signs of intraspinal pathology. Six patients (4.7%) had transient incidences; however, in four patients (3.1%), an intervention was required for the normalization of action potentials. Three of them had an MC >70 degrees, which was significantly higher than the expected value. Eight patients (6.1%) had intraspinal pathologies, and two of them (1.5%) underwent decompression. We suggest the continuation of MRI screening preoperatively and, most importantly, the use of IOM. In three cases with no signs of pathology in the MRI, IOM prevented possible neurological injuries. MCs >70 degrees should be considered a risk factor for the occurrence of neurophysiological deficiencies that require action to be normalized.
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Boachie-Adjei O, Duah HO, Sackeyfio A, Yankey KP, Lenke LG, Sponseller PD, Samdani AF, Sucato DJ, Sides BA, Newton PO, Shah SA, Akoto H, Gupta MC. Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings. Spine Deform 2022; 10:595-606. [PMID: 35305251 DOI: 10.1007/s43390-021-00460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
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Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | | | | | | | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | | | - Brenda A Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Suken A Shah
- Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA
| | | | - Munish C Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
Our objective is to report and define 'operative time' in adolescent idiopathic scoliosis (AIS) posterior spinal fusion surgeries. Documenting key times during surgery are important to compare operative risks, assess learning curves, and evaluate team efficiency in AIS surgery. 'Operative time' in literature has not been standardized. Systematic review was performed by two reviewers. Keywords included operative time, duration of surgery, and scoliosis. One thousand nine hundred six studies were identified, 1092 duplicates were removed and 670 abstracts were excluded. Of the 144 articles, 67 met inclusion and exclusion criteria. Studies were evaluated for number of patients, operative time, and definition of operative time. Meta-analysis was not performed due to confounders. Of the 67 studies (6678 patients), only 14 (1565 patients) defined operative time, and all specified as incision to closure. From these 14 studies, the median operative time was 248 minutes (range 174-448 minutes). In the 53 studies (5113 patients) without a definition, one study reported time in a non-comparable format, therefore, data were analyzed for 52 studies (5078 patients) with a median operative time of 252 minutes (wider range 139-523 minutes). A clear standardized definition of operative or surgical time in spine surgery does not exist. We believe that operative time should be clearly described for each published study for accurate documentation and be defined from incision time to spine dressing completion time in order to standardize study results. Level of evidence: IV.
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Gatam L, Luthfi APWY, Fachrisal, Phedy, Gatam AR, Djaja YP. A posterior-only approach for treatment of severe adolescent idiopathic scoliosis with pedicle screw fixation: A case series. Int J Surg Case Rep 2020; 77:39-44. [PMID: 33137670 PMCID: PMC7610025 DOI: 10.1016/j.ijscr.2020.10.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/16/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
Mean major coronal correction rate was 67%. Pedicle screws provide three-dimensional deformity correction. Posterior spinal fusion alone (PSF) obtains a good and stable correction for severe scoliosis.
Introduction Adolescent idiopathic scoliosis (AIS) can lead to severe deformity. However, early detection and treatment can prevent its progression. Surgical instrumentation for scoliosis treatment has evolved from Harrington instrumentation to pedicle screws. However, there are still some concerns about the efficacy and long-term effects of pedicle screw fixation, and the clinical and radiographic outcomes of surgical treatment for severe AIS (>90°) by posterior spinal fusion alone need to be established. Presentation of case Eight patients with severe and rigid idiopathic scoliosis were recruited for this study. All surgeries were performed by one senior spine surgeon between 2015 and 2018. Free hand technique, intraoperative neurophysiologic monitoring (IONM), and intraoperative fluoroscopy to assess the screw position was performed. Discussion Severe scoliosis results in a complex three-dimensional spinal deformity that often requires correction in multiple planes. Mean major coronal correction rate was 67% (45–80%). No major complications occurred during the perioperative period and after one year follow up. Conclusion Pedicle screws provide three-dimensional deformity correction. There were no complications other than the low-grade late implant-associated infections. Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction for severe scoliosis.
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Affiliation(s)
- Luthfi Gatam
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Andi Praja Wira Yudha Luthfi
- Resident of Orthopaedic Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Fachrisal
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Phedy
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Asrafi Rizki Gatam
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Yoshi Pratama Djaja
- Department of Orthopaedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
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High density all-pedicle screw technique in correction of high-degree (≥70 degrees) scoliosis with sequential derotation without osteotomies. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Is Anterior Release Obsolete or Does It Play a Role in Contemporary Adolescent Idiopathic Scoliosis Surgery? A Matched Pair Analysis. J Pediatr Orthop 2020; 40:e161-e165. [PMID: 31368923 DOI: 10.1097/bpo.0000000000001433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A retrospective analysis of a prospectively collected database was performed. OBJECTIVE The purpose of this study is to compare 3-dimensional correction associated with the anterior release (AR) and contemporary posterior instrumentation versus posterior-only surgery. SUMMARY OF BACKGROUND DATA The role of AR as a tool in the treatment of adolescent idiopathic scoliosis (AIS) has seen a decline with the popularization of thoracic pedicle screw instrumentation. METHODS Five surgeons were queried for all surgical thoracic AIS cases from 2003 to 2010 treated with thoracoscopic AR/fusion and contemporary posterior instrumentation and fusion and thoracic pedicle screw instrumentation (>80% screws) with 2-year follow-up. These cases were then matched with posterior spinal fusion only cases from a multicenter prospective database. The 2 groups were matched on the basis of major curve magnitude within 5 degrees, T5-T12 kyphosis within 9 degrees, and angle of trunk rotation within 9 degrees. Radiographic and clinical parameters were compared for the 2 groups. Continuous variables were analyzed with analysis of variance and categorical dependent variables with the χ test. RESULTS A total of 47 cases of AR were matched to 47 (1:1 match) posterior spinal fusion cases. Preoperative parameters were similar between groups (P>0.05). Postoperatively, AR cases had a lower major curve (20 vs. 25 degrees, P=0.034; 72% vs. 66% correction, P=0.037). T5-T12 kyphosis was greater in the AR cases (26 vs. 20 degrees; P=0.005). The angle of trunk rotation was similar for the groups. Anchor density was lower in the AR group (1.6 vs. 1.9; P<0.0001). There were 3 complications associated with the AR: 1 pneumothorax and 2 conversions to minithoracotomies for failure to maintain single lung ventilation. CONCLUSIONS AR improves coronal and sagittal plane correction in contemporary AIS surgery with a satisfactory complication profile with less pedicle screw density required for clinically similar corrections. A further prospective study on the benefits of AR may help define specific indications.
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Toombs C, Lonner B, Fazal A, Boachie-Adjei O, Bastrom T, Pellise F, Ramadan M, Koptan W, ElMiligui Y, Zhu F, Qiu Y, Shufflebarger H. The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country? Spine Deform 2019; 7:883-889. [PMID: 31731998 DOI: 10.1016/j.jspd.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The prevalence of adolescent idiopathic scoliosis (AIS) in diverse regions of the world has been studied. Access to care varies widely, and differences in disease severity and operative treatment outcomes are not well understood. This study aimed to determine variation in disease presentation and operative complications for AIS patients from an international cohort. METHODS This is a retrospective study carried out at seven surgical centers in the United States (Manhattan and Miami), Ghana, Pakistan, Spain, Egypt, and China. A total of 541 consecutive patients with AIS were evaluated. Preoperative major curve magnitude, operative parameters, and complications were compared among sites using analysis of variance with post hoc tests and Pearson correlation coefficients. Univariate and multivariate forward stepwise binary logistic regressions determined the variables most predictive of complications. RESULTS Countries with lowest-access to care (Ghana, Egypt, and Pakistan) displayed larger curves, more levels fused, longer operative time (OT), and greater estimated blood loss (EBL) than the other countries (p ≤ .001). Increasing curve magnitude was correlated with greater levels fused, longer OT, and greater EBL in all groups (p = .01). In the univariate regression analysis, Cobb magnitude, levels fused, EBL, and OT were associated with complication occurrence. Only OT remained significantly associated with complication occurrence after adjusting for Cobb magnitude, levels fused, and site (odds ratio [OR] = 1.005, 95% confidence interval 1.001-1.007, p = .003). Complications were greatest in Pakistan and Ghana (21.7% and 13.5%, respectively) and lowest in Miami (6.5%). CONCLUSIONS Larger curve magnitudes in the least-access countries correlated with more levels fused, longer OT, and greater EBL, indicating that increased curve magnitude at surgery could explain the difference in operative morbidity between low- and high-access countries. With OT as the prevailing predictive factor of complications, we suggest that increased curve magnitude leads to longer OTs and more complications. A lack of access to orthopedic care may be the largest contributor to the postponement of treatment. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Courtney Toombs
- Department of Orthopaedics & Rehabilitation, Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, USA
| | - Baron Lonner
- Mount-Sinai Beth Israel Medical Center, Department of Orthopedics, 281 1st Ave, New York, NY 10003, USA.
| | - Akil Fazal
- Nairobi Spine and Orthopaedic Centre, Department of Orthopaedics, Fortis Suites, 1st Floor, Hospital Rd, Nairobi, Kenya
| | | | - Tracey Bastrom
- Pediatric Orthopedics & Scoliosis Center, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA
| | - Ferran Pellise
- Department of Traumatology, Orthopaedic Surgery and Emergency, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain
| | - Mohamed Ramadan
- Department of Orthopaedics, Tanta University, El-Gaish, Tanta Qism 2, Tanta, Gharbia Governorate, Tanta, Egypt
| | - Wael Koptan
- Department of Orthopaedics and Traumatology, Cairo University, 1 Gamaa Street, P.O. Box 12613, Giza, Cairo, Egypt
| | - Yasser ElMiligui
- Department of Orthopaedics and Traumatology, Cairo University, 1 Gamaa Street, P.O. Box 12613, Giza, Cairo, Egypt
| | - Feng Zhu
- Spine Surgery, Nanjing University Drum Tower Hospital, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, China 210008
| | - Yong Qiu
- Spine Surgery, Nanjing University Drum Tower Hospital, 321 Zhongshan Rd, Gulou Qu, Nanjing Shi, Jiangsu Sheng, China 210008
| | - Harry Shufflebarger
- Division of Pediatric Spinal Surgery, Miami Children's Hospital, 3100 SW 62nd Ave, Miami, FL 33155, USA
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Delman C, Cage JM, Lausé G, Roberto R, Gupta MC, Klineberg E. Anterior and Posterior Fusion for Large, Rigid Idiopathic Scoliosis: Does Implant Density Matter? World Neurosurg 2019; 134:e37-e45. [PMID: 31470168 DOI: 10.1016/j.wneu.2019.08.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite advancements in surgical techniques, controversy remains regarding the optimal implant density for the correction of idiopathic scoliosis. Recent evidence has suggested that equivalent radiographic and clinical outcomes can be achieved with lower implant densities for those with moderate curves and good flexibility. Among the experts, the consensus has continued that higher implant densities should be used for larger, stiffer curves. The purpose of the present study was to compare the radiographic results between high-implant density (HID) and low-implant density (LID) constructs in patients with large (>65°), rigid (<50% flexibility) curves who had undergone anterior release and posterior spinal fusion. METHODS We reviewed the idiopathic scoliosis cases performed at a single institution from 2006 to 2014. Only those meeting the inclusion criteria were selected. The patients were divided into HID and LID groups. The postoperative radiographs were compared for coronal correction, thoracic kyphosis, pelvic tilt, lumbar lordosis, and sagittal vertical axis. RESULTS A statistically significant improvement in coronal correction was detected in the HID group at all follow-up points (final follow-up: HID, 81.1% vs. LID, 70.4%; P = 0.01). When preoperative thoracic kyphosis was considered, no differences were found between the 2 groups. No differences were found in the other sagittal parameters. CONCLUSION In patients with large, rigid idiopathic scoliosis undergoing anterior release and posterior spinal fusion, a small, but statistically, significant improvement in the coronal Cobb angle was seen. It remains to be determined whether this small difference in radiographic correction will have any influence on the clinical outcome.
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Affiliation(s)
- Connor Delman
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA
| | - J Matthew Cage
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
| | - Greg Lausé
- Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Rolando Roberto
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA; Department of Orthopaedic Surgery, Shriners Hospital for Children, Northern California, Sacramento, California, USA
| | - Munish C Gupta
- Department of Orthopedic Surgery, School of Medicine, Washington University, Saint Louis, Missouri, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA; Department of Orthopaedic Surgery, Shriners Hospital for Children, Northern California, Sacramento, California, USA
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Erdem MN, Oltulu I, Karaca S, Sari S, Aydogan M. Intraoperative Halo-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves between 70° and 90°: Is It Effective? Asian Spine J 2018; 12:678-685. [PMID: 30060376 PMCID: PMC6068402 DOI: 10.31616/asj.2018.12.4.678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022] Open
Abstract
Study Design A retrospective clinical study. Purpose To analyze the surgical outcomes of intraoperative halo-femoral traction (HFT) in patients with adolescent idiopathic scoliosis (AIS) with Cobb angles between 70° and 90° and flexibility <35%. Overview of Literature Numerous methods have been described to achieve adequate correction and successful results in the surgical treatment of AIS patients with a Cobb angle >70°. However, few studies have evaluated the results of HFT in AIS patients with Cobb angles between 70° and 90° and flexibility <35%. Methods The study comprised 24 AIS patients (18 females, six males; mean age, 17.4 years; mean preoperative Cobb angle, 80.1°; range, 70°–90°) who underwent surgery using intraoperative HFT. Neurological status was constantly assessed during the surgery using intraoperative neurophysiological monitoring. Results The mean follow-up period was 33.5 months. Radiographic outcomes demonstrated 85.7% correction of the major Cobb angle. Coronal and sagittal balance was achieved in all the patients, and shoulder levels were equalized. The traction was discontinued when a decrease in spinal cord potentials was observed during the surgery. Conclusions Intraoperative HFT is an effective and reliable method for the management of scoliosis curves between 70° and 90°. The most significant advantages of the method are avoidance of the morbidities related to anterior surgery, osteotomy, or vertebral column resection; its contribution in helping achieve adequate reduction and optimum balance by the gradually increased corrective force, lack of any need for extreme correction force during instrumentation; and the high correction rates achieved.
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Affiliation(s)
- Mehmet Nuri Erdem
- Department of Orthopaedics and Traumatology, Hisar Intercontinental Hospital, İstanbul, Turkey
| | - Ismail Oltulu
- Fulya Orthopaedic and Spine Center, İstanbul, Turkey
| | - Sinan Karaca
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Training and Research Hospital, İstanbul, Turkey
| | - Seçkin Sari
- Fulya Orthopaedic and Spine Center, İstanbul, Turkey
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Prevalence, Risk Factors, and Characteristics of the "Adding-On" Phenomenon in Idiopathic Scoliosis After Correction Surgery: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2018; 43:780-790. [PMID: 28937532 DOI: 10.1097/brs.0000000000002423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A systematic review and meta-analysis. OBJECTIVE To discuss the prevalence, risk factors, and characteristics of the "adding-on" phenomenon in idiopathic scoliosis (IS). SUMMARY OF BACKGROUND DATA There are controversies on the prevalence and risk factors of the "adding-on" phenomenon. In addition, there is no comprehensive study to describe the characteristics of "adding-on" in IS patients. METHODS We performed a systematic online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies. Effect size (ES), odds ratios (OR), and weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate the incidence, characteristics, and risk factors for "adding-on," respectively. RESULTS The overall pooled prevalence of "adding-on" was 14%. Subgroup analysis showed that the prevalence of "adding-on" in Lenke 1A adolescent idiopathic scoliosis (AIS), Lenke 2 AIS, Lenke 5 AIS, and mixed AIS was 15%, 12%, 9%, and 16%, respectively. AIS patients with the "adding-on" phenomenon had smaller proximal thoracic curve (PTC), main thoracic curve (MTC), clavicle angle, T1 tilt angle and radiographic shoulder height (RSH), and larger correction of PTC. Age, Risser sign, preoperative PTC, preoperative MTC, preoperative lumbar curve (LC), preoperative coronal balance and sagittal balance, and T4 tile were identified as risk factors of "adding-on." Selection of lower instrumented vertebra (LIV) was also an important risk factor as LIV-Center Sacral Vertical Line (CSVL), LIV-end vertebra, LIV-Stable Vertebra, and LIV-Neutral vertebra, and deviation of LIV+1 was found to be significantly associated with "adding-on." Besides, postoperative MTC was also significantly different between patients with and without "adding-on." CONCLUSION The pooled prevalence varied differently in different types of IS. Patients with "adding-on" had smaller PTC, MTC, angle, T1 tilt angle and RSH, and larger correction of PTC. Younger age, less skeletal maturity, smaller preoperative PTC, smaller preoperative MTC, smaller preoperative LC, larger preoperative coronal, sagittal imbalance, selection of LIV, and overcorrection of coronal and sagittal alignment were risk factors for "adding-on." LEVEL OF EVIDENCE 4.
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Cheng MF, Ma HL, Lin HH, Chou PH, Wang ST, Liu CL, Chang MC. Anterior release may not be necessary for idiopathic scoliosis with a large curve of more than 75° and a flexibility of less than 25. Spine J 2018; 18:769-775. [PMID: 28939170 DOI: 10.1016/j.spinee.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/28/2017] [Accepted: 09/11/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To improve correction and fusion rates, an anterior release is often needed for the treatment of idiopathic scoliosis with a curve of more than 75° before posterior correction, instrumentation, and fusion. However, there are disadvantages to anterior release, and we are concerned about whether it is necessary for anterior-posterior spinal fusion in these patients. PURPOSE The objective of this study was to compare the surgical results for idiopathic scoliosis with a curve of more than 75° and a flexibility of less than 25% between using posterior-only approach and combined anterior release followed by posterior correction with a hybrid construct (hooks and pedicle screws) and spinal fusion. STUDY DESIGN/SETTING This was a retrospective cohort study. PATIENT SAMPLE From 2000 to 2014, 388 consecutive patients with idiopathic scoliosis were treated surgically at our hospital. Of these patients, 53 whose primary curves were more than 75° with a flexibility of less than 25%, at an incidence of 13.6%, were included and divided into two groups. Thirty-one patients (mean age: 16.3 years old) who underwent anterior release followed by posterior correction, instrumentation, and fusion were included in the A+P group, and the remaining 22 patients (mean age: 17.3 years old) were designated as the P group for posterior procedure alone. OUTCOME MEASURES The clinical outcomes were analyzed in terms of correction and loss of correction and by the Scoliosis Patient Questionnaire: Version 30 functional questionnaire. MATERIALS AND METHODS In the A+P group, halo-femoral traction was applied for 1 week between the anterior release and the posterior procedure. Posterior instrumentation with a hybrid construct with hooks and pedicle screws was used for both groups. The radiological and functional outcomes were compared between the two groups. RESULTS The average preoperative Cobb angle was 85.3° for the A+P group, with an average 17.4% flexibility, and 80° for the P group, with 15.3% flexibility. The postoperative Cobb angle was 53.1° for the A+P group and 45.6° for the P group. The Cobb angle at the final follow-up for the A+P group was 55.2° and that for the P group was 48°. The average correction rates of the A+P and P groups were 37% and 43.4%, respectively. There were no statistically significant differences between the groups in gender, age, number of levels fused, and flexibility of coronal curve. With a minimum 2-year follow-up, similar results were found between these two groups in terms of correction rate, loss of correction, and functional outcome. CONCLUSIONS In this study, we found that a posterior-only approach with hybrid construct (hooks and pedicle screws) could provide a correction similar to that of an anterior-posterior approach. Also, the disadvantages of anterior release could be avoided by the posterior-only approach.
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Affiliation(s)
- Ming Fai Cheng
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Hsiao-Li Ma
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Hsi-Hsien Lin
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Shih-Tien Wang
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St, Beitou District, Taipei 11221, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan.
| | - Chien-Lin Liu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
| | - Ming-Chou Chang
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong St, Beitou District, Taipei 11221, Taiwan; Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd, Beitou District, Taipei 11217, Taiwan
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Yao G, Cheung JPY, Shigematsu H, Ohrt-Nissen S, Cheung KMC, Luk KDK, Samartzis D. Characterization and Predictive Value of Segmental Curve Flexibility in Adolescent Idiopathic Scoliosis Patients. Spine (Phila Pa 1976) 2017; 42:1622-1628. [PMID: 27997505 DOI: 10.1097/brs.0000000000002046] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A prospective radiographic analysis of adolescent idiopathic scoliosis (AIS) patients managed with alternate-level pedicle screw fixation was performed. OBJECTIVE The objective of this study was to characterize segmental curve flexibility and to determine its predictive value in curve correction in AIS patients. SUMMARY OF BACKGROUND DATA Little is known regarding the distinct segmental curve characteristics and their ability to predict curve correction in patients with AIS. METHODS The segmental Cobb angle was measured on posteroanterior standing radiographs and on fulcrum bending radiographs. Radiographs were analyzed preoperatively and at 2 years postoperatively and the curve was divided into upper, mid, and lower segments based on predefined criteria. The segmental flexibility and the segmental fulcrum bending correction index (FBCI) were calculated. RESULTS Eighty patients were included with mean age of 15 years. Preoperative mean segmental Cobb angles were 18, 31, and 17 degrees in the upper, mid, and lower segments, respectively. Segmental bending Cobb angles were 6, 13, and 4 degrees, respectively, corresponding to segmental flexibilities of 50%, 47%, and 83% in the upper, mid, and lower segments, respectively (P < 0.001). At 2-year follow up, the mean segmental FBCI were 155%, 131%, and 100% in the upper, mid, and lower segments, respectively (P < 0.001), which suggested that the lower segment of the curve was more flexible than the other segments and that higher correction was noted in the upper segments. A significant, positive correlation was noted between the segmental bending Cobb angle and the segmental FBCI (P < 0.05), whereby the strength of the correlation varied based on the curve segment. CONCLUSION This is the first study to demonstrate the segmental variations in curve flexibility using the fulcrum bending radiograph in AIS patients. Curve flexibility is not uniform throughout the curve and different segments exhibit greater flexibility/correctibility than others. Segmental flexibility should be considered in assessing AIS patients and in the clinical decision-making strategy to optimize curve correction outcomes. LEVEL OF EVIDENCE 03.
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Affiliation(s)
- Guanfeng Yao
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
- Department of Orthopedics, Shantou University Medical College, Guangdong, China
| | - Jason P Y Cheung
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Hideki Shigematsu
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
- Department of Orthopedic Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Søren Ohrt-Nissen
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
- Department of Orthopedics, Rigshospitalet, Denmark
| | - Kenneth M C Cheung
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Keith D K Luk
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
| | - Dino Samartzis
- Department of Orthopedics and Traumatology, University of Hong Kong, Pokfulam, Hong Kong, SAR, China
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Comparative Analysis of Combined (First Anterior, Then Posterior) Versus Only Posterior Approach for Treating Severe Scoliosis: A Mean Follow Up of 8.5 Years. Spine (Phila Pa 1976) 2017; 42:831-837. [PMID: 28125525 PMCID: PMC5427990 DOI: 10.1097/brs.0000000000002059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, one center, institutional review board approved study. OBJECTIVE Two methods of operative treatments were compared in order to evaluate whether a two-stage approach is justified for correction of bigger idiopathic scoliosis curves. Two stage surgery, combined anterior approach in first operation and posterior instrumentation and correction in the second operation. One stage surgery included only posterior instrumentation and correction. SUMMARY OF BACKGROUND DATA Studies comparing two-stage approach and only posterior approach are rather scarce, with shorter follow up and lack of clinical data. METHODS Three hundred forty eight patients with idiopathic scoliosis were operated using Cotrel-Dubousset (CD) hybrid instrumentation with pedicle screw and hooks. Only patients with curvatures more than or equal to 61° were analyzed and divided in two groups: two stage surgery (N = 30) and one stage surgery (N = 46). The radiographic parameters as well as duration of operation, hospitalization time, and number of segments included in fusion and clinical outcome were analyzed. RESULTS No statistically significant difference was observed in correction between two-stage group (average correction 69%) and only posterior approach group (average correction 66%). However, there were statistically significant differences regarding hospitalization time, duration of the surgery, and the number of instrumented segments. CONCLUSION Two-stage surgery has only a limited advantage in terms of postoperative correction angle compared with the posterior approach. Posterior instrumentation and correction is satisfactory, especially taking into account that the patient is subjected to only one surgery. LEVEL OF EVIDENCE 3.
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Thoracoscopic Vertebrectomy for Thoracolumbar Junction Fractures and Tumors: Surgical Technique and Evaluation of the Learning Curve. Clin Spine Surg 2016; 29:E344-50. [PMID: 27137153 DOI: 10.1097/bsd.0b013e318286fa99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE The authors evaluated the surgical technique and learning curve for video-assisted thoracoscopic surgery (VATS) for treating thoracolumbar junction burst fractures and bony tumors by examining surgical data and outcome for the first 30 VATS procedures performed by a single surgeon at a training institution. SUMMARY OF BACKGROUND DATA VATS is commonly used in the treatment of early-stage lung cancer. Widespread use of this technique among neurosurgeons is limited by the lack of cases and the steep learning curve. METHODS This study was a retrospective case series of the first 30 T12 and L1 thoracoscopic vertebrectomies from 2003 to 2008. The sample was limited to 1 surgeon and 1 region of the spine to minimize the potential variation so that a learning curve could be assessed. Surgical data and outcomes were analyzed. Estimated blood loss and operation time were analyzed using a linear generalized estimating equation model with a first-order autoregression correlation structure. RESULTS The average operative time for thoracoscopic corpectomy was 270±65 minutes (range, 160-416 min). Operating room time decreased significantly after the first 3 operations. The authors observed a stable linear decrease in operating time over the course of the study. The average blood loss during the thoracoscopic procedure was 433±330 mL (range, 100-1500 mL) and did not change as the series progressed. Complications and conversions to open procedures occurred in 2 patients and were evenly distributed throughout the series. CONCLUSIONS Thoracoscopic vertebrectomy at the thoracolumbar junction has a relatively long learning curve. In this series, operating room time improved dramatically after the first 3 cases but continued to improve subsequently. The learning curve can be accomplished without an increase in blood loss, complications, rate of conversion to open procedures, or frequency of misplaced instrumentation.
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Haber LL, Hughes JD, Womack ED, Roberson RM, Wright PB. Screw Versus Hybrid Constructs for Flexible Thoracic Curves in Adolescent Idiopathic Scoliosis: A Prospective, Randomized Study. Spine Deform 2014; 2:367-373. [PMID: 27927334 DOI: 10.1016/j.jspd.2014.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Prospective, computer-randomized design. OBJECTIVE Compare screw and hybrid constructs in flexible, thoracic curves for adolescent idiopathic scoliosis (AIS) in a prospective randomized fashion. SUMMARY OF BACKGROUND The consensus in scientific literature is that all-screw constructs correct AIS better than hooks in the lumbar and in large, stiff thoracic curves. However, debate continues whether all-screw constructs outperform hybrid constructs in small, flexible thoracic AIS. To our knowledge, this is the first prospective, randomized scoliosis study that examines measures of correction and patient satisfaction with the Scoliosis Research Society-30 (SRS-30) questionnaire. METHODS A total of 45 enrolled AIS patients with flexible, thoracic curves were given an identification number with an associated computer-generated randomization to the hybrid (n = 22) or screw group (n = 23). The treating surgeon received the randomization 2-3 days before surgery. Data including major Cobb (MC), truncal rotation (TR), rib index (RI), secondary curve (SC), and SRS-30 questionnaire were collected preoperatively and postoperatively at 4 weeks and 3, 6, 12, and 24 months. RESULTS Thirty-seven patients in the hybrid (n = 18) and screw (n = 19) groups completed the study with a mean follow-up of 26 months (range, 24-49 months). Hybrid versus screw group means for preoperative, postoperative, and final follow-up were: MC 58° ± 8° versus 55° ± 6°, 18° ± 8° versus 15° ± 7°, and 23°± 8° versus 14° ± 6°; TR 14° ± 6° versus 16° ± 4°, 10° ± 5° versus 7° ± 3°, and 11° ± 5° versus 7° ± 4°; RI 3.0° ± 1.2° versus 3.4° ± 1.4°, 2.5° ± 0.7° versus 1.8° ± 0.6°, and 2.5° ± 0.8° versus 2.0° ± 0.5°; SC 35° ± 13° versus 31° ± 8°, 13° ± 11° versus 7° ± 9°, and 13° ± 12° versus 7° ± 7°; and SRS-30 3.9 ± 0.2 versus 3.9 ± 0.2, 4.1 ± 0.4 versus 4.0 ± 0.3, and 4.1 ± 0.3 versus 4.0 ± 0.2. CONCLUSIONS Intergroup preoperative and early postoperative values were comparable (p > .05). At final follow-up, owing to loss of correction in the hybrid group, differences in MC (9°; p = .000), RI (0.54; p = .016), and TR (4°; p = .039) correction were statistically significant as SC trended toward significance (6°; p = .052). All-screw constructs outperformed hybrid constructs, especially over time. No differences in SRS-30 scores occurred between groups.
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Affiliation(s)
- Lawrence L Haber
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Joshua D Hughes
- Department of Neurosurgery, Mayo Graduate School of Medical Education, 200 1st Street SW, Rochester, MN 55905, USA
| | - Erika D Womack
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Rowland M Roberson
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Patrick B Wright
- Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22 Suppl 6:S808-14. [PMID: 24061974 DOI: 10.1007/s00586-013-3027-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 09/08/2013] [Accepted: 09/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Posterior-only approach arthrodesis by all-pedicle screw instrumentation has a correction rate similar to correction obtained by traditional combined anterior/posterior approach surgery and avoids the complications associated with the thoracic approach. METHODS We treated 25 patients, with a mean age 16.5 years, with severe adolescent idiopathic scoliosis by posterior-only approach using all-screw instrumentation arthrodesis. Mean scoliosis curve in Cobb degrees was 95° Cobb. All cases were treated by the same senior surgeon, by free hand technique, without intraoperative neurophysiologic monitoring and spine navigation aids. RESULTS Mean scoliosis curve after surgery was 37° Cobb. Mean follow-up was 4 years. No perioperative complications, curve progression or arthrodesis malunion were reported at the follow-up. CONCLUSIONS Posterior spinal fusion with pedicle screw-only instrumentation obtains a good and stable correction of severe scoliosis; compared to hybrid instrumentation, it allows a greater coronal correction of the deformity and less correction loss at the follow-up.
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Cheung KMC, Natarajan D, Samartzis D, Wong YW, Cheung WY, Luk KDK. Predictability of the fulcrum bending radiograph in scoliosis correction with alternate-level pedicle screw fixation. J Bone Joint Surg Am 2010; 92:169-76. [PMID: 20048109 DOI: 10.2106/jbjs.h.01831] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The fulcrum bending radiograph accurately predicts scoliosis curve correction in patients with thoracic adolescent idiopathic scoliosis who are managed with hooks. We assessed the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation of the scoliotic spine. METHODS A prospective radiographic analysis of patients with thoracic adolescent idiopathic scoliosis who were managed operatively with alternate-level pedicle screw fixation at a single institution was performed. The Cobb angle was measured on posteroanterior standing coronal radiographs that were made preoperatively and one week postoperatively. The fulcrum flexibility percentage and the fulcrum bending correction index percentage were calculated. RESULTS Forty-two patients were assessed. The mean age at the time of surgery was 14.6 years, and the mean number of fused levels was 9.4. On the preoperative radiographs, the mean values for the standing Cobb angle, the fulcrum bending radiograph Cobb angle, and fulcrum flexibility were 57.9 degrees, 21.8 degrees, and 62.7%, respectively. On the one-week postoperative radiographs, the mean Cobb angle was 15.4 degrees, the mean curve correction was 73.4%, and the mean fulcrum bending correction index was 122.1%. A significant, positive correlation was noted between the fulcrum bending radiograph angle and the fulcrum bending correction index, indicating that the fulcrum bending radiograph could predict the correction of flexible curves; however, for stiff curves, pedicle screws could provide more correction than the fulcrum bending radiograph predicted. CONCLUSIONS To our knowledge, this is the first study to demonstrate the predictive value of the fulcrum bending radiograph in the context of alternate-level pedicle screw fixation in patients with adolescent idiopathic scoliosis. Curve flexibility may dictate the degree of the fulcrum bending correction index, whereby a curve that is less flexible may achieve a greater fulcrum bending correction index. The fulcrum bending radiograph has potential predictive utility. In addition, pedicle screw constructs appear to have a better ability to correct scoliosis in comparison with hooks and hybrid constructs.
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Affiliation(s)
- Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, Duchess of Kent Children's Hospital, Hong Kong, China
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Bullmann V, Liljenqvist UR, Schmidt C, Schulte TL. [Posterior operative correction of idiopathic scoliosis. Value of pedicle screws versus hooks]. DER ORTHOPADE 2009; 38:198-200, 202-4. [PMID: 19093095 DOI: 10.1007/s00132-008-1370-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Posterior correction and fusion of scoliosis with multisegmental instrumentation systems was developed by Cotrel-Dubousset in the 1980s. Initially correction and instrumentation was performed using hooks only. Later pedicle screws were implemented first for the lumbar and then for the thoracic spine. Nowadays instrumentation based on pedicle screws only is well established for posterior scoliosis surgery. Biomechanical studies demonstrated higher pull-out forces for pedicle than for hook constructs.In clinical studies several authors reported better Cobb angle correction of the primary and the secondary curves and less loss of correction in pedicle screw versus hook instrumentations. Furthermore, pedicle screw instrumentation allows fewer segments to be fused, especially caudally, and thus saving mobile segments. In most of these publications there were no differences in operation time, blood loss and complication rates. In summary, there is better curve correction without an increased risk using multisegmental pedicle screw instrumentation in modern posterior scoliosis surgery.
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Affiliation(s)
- V Bullmann
- Sektion Wirbelsäulenorthopädie, Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum, Münster, Deutschland.
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Posterior multilevel vertebral osteotomy for correction of severe and rigid neuromuscular scoliosis: a preliminary study. Spine (Phila Pa 1976) 2009; 34:1315-20. [PMID: 19455007 DOI: 10.1097/brs.0b013e3181a028bc] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To determine the effectiveness and correction with posterior multilevel vertebral osteotomy in severe and rigid curves without anterior release. SUMMARY OF BACKGROUND DATA For the correction of severe and rigid scoliotic curve, anterior-posterior combined or posterior vertebral column resection (PVCR) procedures are used. Anterior procedure might compromise pulmonary functions, and PVCR might carry risk of neurologic injuries. Therefore, authors developed a new technique, which reduces both. METHODS Thirteen neuromuscular patients (7 cerebral palsy, 2 Duchenne muscular dystrophy, and 4 spinal muscular atrophy) who had rigid curve >100 degrees were prospectively selected. All were operated with posterior-only approach using pedicle screw construct. To achieve desired correction, posterior multilevel vertebral osteotomies were performed at 3 to 5 levels (apex, and 1-2 levels above and below apex) through partial laminotomy sites connecting from concave to convex side, just above the pedicle; and repeated cantilever manipulation was applied over temporary short-segment fixation, above and below the apex, on convex side. On concave side, rod was assembled with screws and rod-derotation maneuver was performed. Finally, short-segment fixation on convex side was replaced with full-length construct. Intraoperative MEP monitoring was applied in all. RESULTS Mean age was 21 years and average follow-up was 25 months. Average preoperative flexibility was 20.3% (24.1 degrees). Average Cobb's angle, pelvic obliquity, and apical rotation were 118.2 degrees, 16.7 degrees, and 57 degrees preoperatively, respectively, and 48.8 degrees, 8 degrees, and 43 degrees after surgery showing significant correction of 59.4%, 46.1%, and 24.5%. Average number of osteotomy level was 4.2 and average blood loss was 3356 +/- 884 mL. Mean operation time was 330 +/- 46 minutes. None of the patient required postoperative ventilator support or displayed any signs of neurologic or vascular injuries during or after the operation. CONCLUSION This technique should be recommended because (1) it provides release of anterior column without anterior approach and (2) our results supports its superiority as a technique.
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Arlet V, Shilt J, Bersusky E, Abel M, Ouellet JA, Evans D, Menon KV, Kandziora F, Shen F, Lamartina C, Adams M, Reddi V. Experience with an online prospective database on adolescent idiopathic scoliosis: development and implementation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1497-506. [PMID: 18830720 PMCID: PMC2583197 DOI: 10.1007/s00586-008-0779-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 07/28/2008] [Accepted: 08/31/2008] [Indexed: 12/03/2022]
Abstract
Considerable variability exists in the surgical treatment and outcomes of adolescent idiopathic scoliosis (AIS). This is due to the lack of evidence-based treatment guidelines and outcome measures. Although clinical trials have been extolled as the highest form of evidence for evaluating treatment efficacy, the disadvantage of cost, time, lack of feasibility, and ethical considerations indicate a need for a new paradigm for evidence based research in this spinal deformity. High quality clinical databases offer an alternative approach for evidence-based research in medicine. So, we developed and established Scolisoft, an international, multidimensional and relational database designed to be a repository of surgical cases for AIS, and an active vehicle for standardized surgical information in a format that would permit qualitative and quantitative research and analysis. Here, we describe and discuss the utility of Scolisoft as a new paradigm for evidence-based research on AIS. Scolisoft was developed using dot.net platform and SQL server from Microsoft. All data is deidentified to protect patient privacy. Scolisoft can be accessed at (www.scolisoft.org). Collection of high quality data on surgical cases of AIS is a priority and processes continue to improve the database quality. The database currently has 67 registered users from 21 countries. To date, Scolisoft has 200 detailed surgical cases with pre, post, and follow up data. Scolisoft provides a structured process and practical information for surgeons to benchmark their treatment methods against other like treatments. Scolisoft is multifaceted and its use extends to education of health care providers in training, patients, ability to mine important data to stimulate research and quality improvement initiatives of healthcare organizations.
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Affiliation(s)
- Vincent Arlet
- Department of Orthopedic Surgery, University of Virginia, Suite 330, 400 Ray C Hunt Drive, Charlottesville, VA 22908 USA
| | - Jeffrey Shilt
- St. Alphonsus Regional Medical Center, 1085, N Curtis Road, Idaho, ID 83706 USA
| | - Ernesto Bersusky
- Hopsital De Pediatria Garrahan, Billinghurst 1676 PBC, Buenos Aires, 1425 Argentina
| | - Mark Abel
- Department of Orthopedic Surgery, University of Virginia, Suite 330, 400 Ray C Hunt Drive, Charlottesville, VA 22908 USA
| | - Jean Albert Ouellet
- Orthopedic Surgery, McGill University Health Center, MCH, 2300 Tupper, Montreal, QC H3HIP3 Canada
| | - Davis Evans
- Southampton General Hospital, Southampton University Hospital Trust, Southampton, SO16 6YD UK
| | - K. V. Menon
- Lakeshore Hospital and Research Center, Maradu, NH-47 Bypass, Nettoor, PO Box 682304, Cochin, Kerala India
| | - Frank Kandziora
- Center for Spine Surgery and Neurotraumatology, Friedberger Lanstrasse 4340, 60389 Frankfurt am Main, Germany
| | - Frank Shen
- Department of Orthopedic Surgery, University of Virginia, Suite 330, 400 Ray C Hunt Drive, Charlottesville, VA 22908 USA
| | - Claudio Lamartina
- Spine Surgery Department, Instituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Marc Adams
- Aspire Software Development, Wartbodenstrasse 1 g, 3626 Huenibach, Switzerland
| | - Vasantha Reddi
- Department of Orthopedic Surgery, University of Virginia, Suite 330, 400 Ray C Hunt Drive, Charlottesville, VA 22908 USA
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Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: pedicle screws versus hybrid instrumentation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1336-49. [PMID: 18696126 DOI: 10.1007/s00586-008-0731-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 07/14/2008] [Accepted: 07/24/2008] [Indexed: 11/25/2022]
Abstract
The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80 degrees traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80 degrees) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80 degrees (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92 degrees vs. PSF-S: 88 degrees), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9 degrees versus -11.3 degrees (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19 degrees vs. -10 degrees; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups.
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Affiliation(s)
- Mario Di Silvestre
- Spine Surgery Department, Istituti Ortopedici Rizzoli, Via Pupilli 1, 40136, Bologna, Italy.
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Rationale behind the current state-of-the-art treatment of scoliosis (in the pedicle screw era). Spine (Phila Pa 1976) 2008; 33:1051-4. [PMID: 18449036 DOI: 10.1097/brs.0b013e31816f2865] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Comparison of radiographic outcomes for the treatment of scoliotic curves greater than 100 degrees: wires versus hooks versus screws. Spine (Phila Pa 1976) 2008; 33:1084-92. [PMID: 18449042 DOI: 10.1097/brs.0b013e31816f5f3a] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective comparative study. OBJECTIVE To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves > or = 100 degrees using radiographic outcomes and clinical complications. SUMMARY OF BACKGROUND DATA To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves > or = 100 degrees. METHODS Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves > or = 100 degrees (mean, 112.7 degrees; range, 100 degrees -159 degrees ) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated. RESULTS The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit. CONCLUSION All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.
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Abstract
Brace treatment is effective for selected patients with AIS, but when patients mature or curves progress beyond 40 degrees , surgery may be discussed with the patient and family. The advent of third-generation spinal instrumentation with pedicle screw systems has made extraordinary corrections possible. These posterior corrections must be done cautiously, however. When selecting the fusion level, one should always look at the sagittal plane and include any kyphotic segments. The authors evaluate case examples of Lenke type I through type VI curves with illustrations and radiographic images in this additional content, which is only found on-line.
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Son-Hing JP, Blakemore LC, Poe-Kochert C, Thompson GH. Video-assisted thoracoscopic surgery in idiopathic scoliosis: evaluation of the learning curve. Spine (Phila Pa 1976) 2007; 32:703-7. [PMID: 17413478 DOI: 10.1097/01.brs.0000257528.89699.b1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of patients with idiopathic scoliosis who underwent same-day or staged anterior and posterior spinal fusion and segmental spinal instrumentation. OBJECTIVE Evaluation of our learning curve with video-assisted thoracoscopic surgery (VATS) with respect to operative time, blood loss, and complications in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA VATS is a minimally invasive alternative to thoracotomy in the management of idiopathic scoliosis. An increased or steep learning curve has been described in the initial application of this technique. METHODS We began performing VATS in 1998. We compared our first 25 consecutive VATS patients (Group 2) and subsequent 28 consecutive VATS patients (Group 3) to our previous 16 consecutive patients (Group 1) with a thoracotomy (1991-1998) for idiopathic scoliosis. Training at a sponsored regional course was obtained before performing our first VATS procedure. RESULTS VATS allowed more disc to be excised in Group 2 (4.5 +/- 1, 5.7 +/- 1, and 4.4 +/- 1 discs in Group 1, Group 2, and Group 3, respectively) and significantly decreased the anterior operative time (215 +/- 33, 260 +/- 56, and 177 +/- 47 minutes) and time per individual disc excision (50 +/- 13, 47 +/- 12, and 41 +/- 12 minutes), while providing comparable correction of the thoracic deformity (67% +/- 12%, 66% +/- 10%, and 70% +/- 13% correction). There was no increase in estimated intraoperative anterior blood loss (228 +/- 213, 183 +/- 136, and 211 +/- 158 mL), estimated blood loss per disc excised (51 +/- 42, 34 +/- 29 and 48 +/- 37 mL), or complications in the VATS groups. Complications were primarily pulmonary and resolved with medical therapy. Postoperative chest tube drainage (855 +/- 397, 462 +/- 249, and 561 +/- 261 mL) and total perioperative anterior blood loss (1083 +/- 507, 647 +/- 309, and 773 +/- 308 mL) were significantly decreased in the VATS groups, but this was attributed to the use of Amicar. CONCLUSIONS VATS is an effective procedure for anterior spinal fusion in idiopathic scoliosis. The learning curve is short, provided appropriate training is obtained.
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Affiliation(s)
- Jochen P Son-Hing
- Division of Pediatric Orthopedics, Rainbow Babies and Children's Hospital, Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
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Abstract
In adults, symptomatic scoliosis is usually a de novo primary degenerative deformity that develops in the fifth or sixth decade or an unrecognized or untreated idiopathic deformity with superimposed degeneration. The evaluation and treatment of adult scoliosis must focus on addressing patient symptoms while limiting the consequences of the treatment. The presence of neurological deficits, the flexibility of the deformity, the coronal and sagittal balance, and status of spinal segments outside of the main deformity are all important considerations when planning surgery. The complication rate of deformity surgery in adults is potentially high; but excellent functional outcome and patient satisfaction can occur with thorough preoperative patient education and meticulous surgical technique.
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Affiliation(s)
- Rod J Oskouian
- Department of Neurological Surgery, University of Virginia, PO Box 800212, Charlottesville, VA 22902, USA
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Arlet V. Comment regarding "Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films" (A. Hempfing et al.). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 16:521-2. [PMID: 17033853 PMCID: PMC2229814 DOI: 10.1007/s00586-006-0230-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Vincent Arlet
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray Hunt Drive, P.O. Box 800159, Charlottesville, VA 22908, USA.
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Hempfing A, Ferraris L, Koller H, Rump J, Metz-Stavenhagen P. Is anterior release effective to increase flexibility in idiopathic thoracic scoliosis? Assessment by traction films. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 16:515-20. [PMID: 17033854 PMCID: PMC2229813 DOI: 10.1007/s00586-006-0229-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2006] [Revised: 07/31/2006] [Accepted: 09/06/2006] [Indexed: 10/24/2022]
Abstract
With the advent of thoracoscopy, anterior release procedures in adolescent idiopathic scoliosis (AIS) have come into more frequent use, however, the indication criteria for an anterior release in thoracic AIS are still controversial in the literature. To date, few studies have assessed the influence on spinal flexibility and no study has so far been able to show a beneficial effect on the correction rate as compared to a single posterior procedure. The objective of this study was to evaluate the influence of thoracic disc excision on coronal spinal flexibility. Six patients (5 females, 1 male) with AIS and a mean age of 15.6 years (range 13-20 years) underwent an open anterior thoracic release prior to posterior instrumentation. Cotrel dynamic traction along with radiographs of the whole spine including traction films were conducted pre- and postoperatively and were evaluated retrospectively. The mean preoperative thoracic curve was 89.7 degrees +/- 15.4 degrees (range 65 degrees-110 degrees). The flexibility rate in Cotrel traction was 22.8 +/- 8.1%. After performance of the anterior release the thoracic curve showed a mean increase of coronal correction by 5.5 degrees +/- 5.0 degrees as assessed by traction radiographs. The flexibility index changed by 6.2 +/- 5.6%. After posterior instrumentation the thoracic curve was corrected to a mean of 36.5 degrees +/- 10.1 degrees (correction rate 59.6%). Disc excision in idiopathic thoracic scoliosis only slightly increased spinal flexibility as assessed by traction films. In our view a posterior release with osteotomy of the concave ribs (concave thoracoplasty, CTP) is more effective in increasing spinal flexibility. According to our clinical experience, an anterior release prior to posterior instrumentation in AIS should only be considered in hyperkyphosis, coronal imbalance or massive curves.
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Affiliation(s)
- A Hempfing
- German Scoliosis Center, Werner-Wicker Klinik, Bad Wildungen-Reinhardshausen, 34125, Germany.
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Bullmann V, Halm HFH, Schulte T, Lerner T, Weber TP, Liljenqvist UR. Combined anterior and posterior instrumentation in severe and rigid idiopathic scoliosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2006; 15:440-8. [PMID: 16408235 PMCID: PMC3489309 DOI: 10.1007/s00586-005-1016-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 07/16/2005] [Accepted: 07/31/2005] [Indexed: 10/25/2022]
Abstract
A prospective clinical and radiographic evaluation of 33 consecutive patients with severe and rigid idiopathic scoliosis (average Cobb angle 93 degrees, flexibility on bending films 23%) were treated with combined anterior and posterior instrumentation with a minimum follow-up of 2 years. All patients underwent anterior release and VDS-Zielke Instrumentation of the primary curve. In highly rigid scoliosis, this was preceded by a posterior release. Finally, posterior correction and fusion with a multiple hook and pedicle screw construct was performed. Thirty patients were operated in one stage, three patients in two stages. Preoperative curves ranged from 80 to 122 degrees Cobb angle. Frontal plane correction of the primary curve averaged 67% with an average loss of correction of 2 degrees . The apical vertebral rotation of the primary curve was corrected by 49%. In all but three patients, sagittal alignment was restored. There were no neurological complications, deep wound infections or pseudarthrosis. Combined anterior and posterior instrumentation is safe and enables an effective three-dimensional curve correction in severe and rigid idiopathic scoliosis.
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Affiliation(s)
- Viola Bullmann
- Department of Orthopedic Surgery, University Hospital of Muenster, Muenster, Germany.
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Arlet V. Comments on "In vivo demonstration of the effectiveness of thoracoscopic anterior release using the fulcrum bending radiograph: a report of five cases" (Cheung et al.). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2005; 15 Suppl 5:583-4. [PMID: 16369829 PMCID: PMC1602187 DOI: 10.1007/s00586-005-0030-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Vincent Arlet
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray Hunt Drive, P.O. Box 800159, Charlottesville, VA 22908, USA.
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Burton DC, Sama AA, Asher MA, Burke SW, Boachie-Adjei O, Huang RC, Green DW, Rawlins BA. The treatment of large (>70 degrees) thoracic idiopathic scoliosis curves with posterior instrumentation and arthrodesis: when is anterior release indicated? Spine (Phila Pa 1976) 2005; 30:1979-84. [PMID: 16135989 DOI: 10.1097/01.brs.0000176196.94565.d6] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study from 2 centers. OBJECTIVE To analyze the efficacy of posterior instrumentation and arthrodesis for thoracic idiopathic scoliosis curves more than 70 degrees. SUMMARY OF BACKGROUND INFORMATION The increasing use of thoracoscopic techniques in deformity surgery has led several investigators to advocate anterior release followed by posterior instrumentation when treating "stiff" thoracic curves 60 degrees-70 degrees. To our knowledge, no study has been published to define indications for anterior surgery in thoracic idiopathic scoliosis. METHODS This is a retrospective review of patients 20 years and younger, with idiopathic scoliosis and thoracic curves more than 70 degrees treated with isolated posterior instrumentation and arthrodesis at 2 institutions from 1989 to 1999. A total of 50 patients were identified, and 46 were available for minimum 2-year radiographic follow-up. Of the 50 patients, 44 had bend films taken before surgery. All patients were treated with third-generation segmental spinal instrumentation using a varied combination of hooks, wires, and screws. RESULTS Average patient age at surgery was 14.4 years (range 10-20), and average radiographic follow-up was 4.4 years (range 2-11.5). Average preoperative thoracic curve was 75 degrees (range 70 degrees-88 degrees), and average bend was 47 degrees (range 28 degrees-60 degrees), a flexibility of 37%. Average postoperative curve was 25 degrees (range 10 degrees-46 degrees), and it was 27 degrees (range 11 degrees-46 degrees) at latest follow-up, a correction of 64%. The average length of surgery was 6.15 hours, mean hospital stay was 8 days, and average blood loss was 1100 cc. The Scoliosis Research Society 22 or 24 was available at a minimum of 2 years in 46 of 50 patients. Mean domain scores were: pain 4.4, self-image 4.3, function 4.3, mental health 4.3, satisfaction 4.7, and total 4.4. Complications included 1 pseudarthrosis, 1 implant removal for prominence, and 1 implant removal for late operative site pain. CONCLUSION Using posterior surgery only, we have been able to at least equal the results reported in the literature by investigators using combined approaches. Isolated posterior instrumentation and arthrodesis achieve satisfactory cosmetic, radiographic, and patient-based outcomes in adolescents with idiopathic scoliosis with thoracic curves 70 degrees-90 degrees, without the added expense and morbidity of anterior release.
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