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Noe MC, Link RC, Warren JR, Etebari CV, Whitmire MH, Anderson JT, Schwend RM. Three-dimensional deformity correction in adolescent idiopathic scoliosis patients: what are the benefits of hybrid apical sublaminar bands versus all-pedicle screws? J Pediatr Orthop B 2024:01202412-990000000-00211. [PMID: 39229888 DOI: 10.1097/bpb.0000000000001204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
The amount of three-dimensional (3D) correction with apical sublaminar band (hybrid-SLB) technique has not been compared to all-pedicle screw instrumentation for adolescent idiopathic scoliosis (AIS) using detailed axial correction metrics or comparable rod types. Our purpose is to compare 3D improvement in AIS deformities following posterior spinal instrumentation and fusion (PSIF) with hybrid-SLB and segmental correction to all-pedicle screw correction. Patients ages 10-18 years with AIS who underwent PSIF between 2015 and 2022 and had preoperative and postoperative EOS imaging were included. Electronic medical records were reviewed for demographic, Lenke classification, operative technique, and 3D EOS data. Average changes in major and minor Cobb angle, axial rotation, thoracic kyphosis, and lumbar lordosis were compared. Ninety-five patients met inclusion criteria with 55 in the hybrid-SLB group (mean age 14.9 ± 1.9 years) and 40 in all-pedicle screw (mean age 14.7 ± 2.1 years). While all-pedicle screw demonstrated greater correction of major (45.7 ± 13.4 vs 37.9 ± 14.3 degrees; P = 0.008) and minor (28.7 ± 13.1 vs 17.8 ± 12.5 degrees; P = 0.001) Cobb angles, hybrid-SLB showed greater increase in T4-T12 kyphosis (13.3 ± 15.3 vs 5.6 ± 13.5 degrees; P = 0.01). Correction of T1-T12 kyphosis, axial rotation, and lumbar lordosis was similar between groups. 3D EOS analysis of AIS patients before and after PSIF revealed that all-pedicle screw constructs had greater overall coronal plane correction and hybrid-SLB had greater thoracic sagittal plane correction. Axial corrective abilities were similar. Hybrid-SLB may have advantages for correction of thoracic lordosis or hypokyphosis. Level of evidence: Level III, retrospective cohort study.
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Affiliation(s)
- McKenna C Noe
- Department of Orthopaedic Surgery, Children's Mercy Kansas City
| | - Robert C Link
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Jonathan R Warren
- Department of Orthopaedic Surgery, Children's Mercy Kansas City
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Cyrus V Etebari
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Morgan H Whitmire
- Department of Orthopaedic Surgery, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - John T Anderson
- Department of Orthopaedic Surgery, Children's Mercy Kansas City
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Faldini C, Viroli G, Traversari M, Manzetti M, Ialuna M, Sartini F, Cargeli A, Parisi SC, Ruffilli A. Ponte Osteotomies in the Surgical Treatment of Adolescent Idiopathic Scoliosis: A Systematic Review of the Literature and Meta-Analysis of Comparative Studies. CHILDREN (BASEL, SWITZERLAND) 2024; 11:92. [PMID: 38255405 PMCID: PMC10814379 DOI: 10.3390/children11010092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
The purpose of the present paper is to assess if Ponte osteotomies (POs) allow for a better correction in adolescent idiopathic scoliosis (AIS) surgery and to investigate their safety profile. A systematic search of electronic databases was conducted. Inclusion criteria: comparative studies that reported the outcomes of AIS patients who underwent surgical correction through posterior-only approach with and without POs. Clinical and radiographic outcomes were extracted and summarized. Meta-analyses were performed to estimate the differences between patients treated with and without POs. p < 0.05 was considered significant. In total, 9 studies were included. No significant difference in thoracic kyphosis (TK) change between patients treated with and without POs was found (+3.8°; p = 0.06). Considering only hypokyphotic patients, a significant difference in TK change resulted in POs patients (+6.6°; p < 0.01), while a non-significant TK change resulted in normokyphotic patients (+0.2°; p = 0.96). No significant difference in coronal correction (2.5°; p = 0.10) was recorded. Significant estimated blood loss (EBL) (142.5 mL; p = 0.04) and surgical time (21.5 min; p = 0.04) differences were found with POs. Regarding complications rate, the meta-analysis showed a non-significant log odds ratio of 1.1 (p = 0.08) with POs. In conclusion, POs allow for the restoration of TK in hypokyphotic AIS, without a significantly greater TK change in normokyphotic patients, nor a significantly better coronal correction. Considering the significantly greater EBL and the trend toward a higher complications rate, the correct indication for POs is crucial.
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Affiliation(s)
- Cesare Faldini
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Giovanni Viroli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Matteo Traversari
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Manzetti
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Marco Ialuna
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesco Sartini
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alessandro Cargeli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Stefania Claudia Parisi
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Alberto Ruffilli
- Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 40126 Bologna, Italy; (G.V.); (M.T.); (M.M.); (M.I.); (F.S.); (A.C.); (S.C.P.); (A.R.)
- 1st Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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Seki S, Makino H, Yahara Y, Kamei K, Futakawa H, Yasuda T, Suzuki K, Nakano M, Kawaguchi Y. Rod Rotation with Outrigger Is Substantial for Correcting Apical Hypokyphosis in Patients with Adolescent Idiopathic Scoliosis: Novel Outrigger Device for Concave Rod Rotation. J Clin Med 2023; 12:6780. [PMID: 37959244 PMCID: PMC10650767 DOI: 10.3390/jcm12216780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
The apical hypokyphosis of scoliotic patients is thought to lead to decreased lung capacity and cause shortness of breath. Additionally, concave rod curve reduction is a problem in the correction of apical hypokyphosis in posterior spinal fusion surgery in adolescent idiopathic scoliosis (AIS). We investigated the contributions of rod rotation (RR) with an outrigger device, followed by differential rod contouring (DRC) with the outrigger attached to the concave rod, designed to prevent concave rod curve-flattening. We analyzed and compared the results of segmental pedicle screw fixation without the outrigger in 41 AIS patients with thoracic curves (Lenke type I, 25; type II, 16) to those corrected using the outrigger in 36 patients (Lenke type I, 24; type II,12). The changes in the Cobb angle, apical kyphosis of five vertebrae, thoracic kyphosis (TK, T4-12), correction rate, correction angle of apical vertebral rotation, spinal penetration index (SPi), and rib hump index (RHi) before and after surgery were measured, and the contribution of the outrigger was analyzed. The mean scoliosis correction rates without and with the outrigger were 72.1° and 75.6°, respectively (p = 0.03). Kyphosis of the five apical vertebrae and TK were significantly greater in the surgery with the outrigger (p = 0.002). Significantly greater improvements in SPi and RHi were also noted in the surgery with the outrigger (p < 0.05). The use of concave RR and convex DRC with the outrigger appear to be advantageous for correcting apical hypokyphosis, followed by the subsequent formation of TK. As a result, breathing problems are less likely to occur during daily life because of improvements in SPi and RHi.
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Affiliation(s)
- Shoji Seki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Hiroto Makino
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Yasuhito Yahara
- WPI-Immunology Frontier Research Center, Osaka University, Suita, Osaka 565-0871, Japan;
| | - Katsuhiko Kamei
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Hayato Futakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Taketoshi Yasuda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Kayo Suzuki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
| | - Masato Nakano
- Department of Orthopaedic Surgery, Takaoka City Hospital, Toyama 933-8550, Japan;
| | - Yoshiharu Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan; (H.M.); (K.K.); (H.F.); (T.Y.); (K.S.); (Y.K.)
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Wan SHT, Wong DLL, To SCH, Meng N, Zhang T, Cheung JPY. Patient and surgical predictors of 3D correction in posterior spinal fusion: a systematic review. 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 2023; 32:1927-1946. [PMID: 37079078 DOI: 10.1007/s00586-023-07708-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/18/2023] [Accepted: 04/07/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Restoration of three-dimensional (3D) alignment is critical in correcting patients with adolescent idiopathic scoliosis using posterior spinal fusion (PSF). However, current studies mostly rely on 2D radiographs, resulting in inaccurate assessment of surgical correction and underlying predictive factors. While 3D reconstruction of biplanar radiographs is a reliable and accurate tool for quantifying spinal deformity, no study has reviewed the current literature on its use in evaluating surgical prognosis. PURPOSE To summarize the current evidence on patient and surgical factors affecting sagittal alignment and curve correction after PSF based on 3D parameters derived from reconstruction of biplanar radiographs. METHODS A comprehensive search was conducted by three independent investigators on Medline, PubMed, Web of Science, and Cochrane Library to obtain all published information on predictors of postoperative alignment and correction after PSF. Search items included "adolescent idiopathic scoliosis," "stereoradiography," "three-dimensional," "surgical," and "correction." The inclusion and exclusion criteria were carefully defined to include clinical studies. Risk of bias was assessed with the Quality in Prognostic Studies tool, and level of evidence for each predictor was rated with the Grading of Recommendations, Assessment, Development, and Evaluations approach. 989 publications were identified, with 444 unique articles subjected to full-text screening. Ultimately, 41 articles were included. RESULTS Strong predictors of better curve correction included preoperative normokyphosis (TK > 15°), a corresponding rod contour, intraoperative vertebral rotation and translation, and upper and lower instrumented vertebrae selected based on sagittal and axial inflection points. For example, for Lenke 1 patients with junctional vertebrae above L1, fusion to NV-1 (1 level above the neutral vertebra) achieved optimal curve correction while preserving motion segments. Pre-op coronal Cobb angle and axial rotation, distal junctional kyphosis, pelvic incidence, sacral slope, and type of instrument were identified as predictors with moderate evidence. For Lenke 1C patients, > 50% LIV rotation was found to increase spontaneous lumbar curve correction. Pre-op thoracolumbar apical translation and lumbar lordosis, Ponte osteotomies, and rod material were found to be predictors with low evidence. CONCLUSIONS Rod contouring and UIV/LIV selection should be based on preoperative 3D TK in order to achieve normal postoperative alignment. Specifically, Lenke 1 patients with high-lying rotations should be fused distally at NV-1, while hypokyphotic patients with large lumbar curves and truncal shift should be fused at NV to improve lumbar alignment. Lenke 1C curves should be corrected using > 50% LIV rotation counterclockwise to the lumbar rotation. Further investigation should compare surgical correction between pedicle-screw and hybrid constructs using matched cohorts. DJK and overbending rods are potential predictors of postoperative alignment.
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Affiliation(s)
- Sandra Hiu-Tung Wan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Darren Li-Liang Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Samuel Ching-Hang To
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Nan Meng
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Jason Pui-Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.
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Berlin C, Quante M, Halm H. [Increased risk of thoracic hypokyphosis after posterior spinal correction and fusion in adolescent idiopathic scoliosis with thoracic double curve]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:233-242. [PMID: 36645436 DOI: 10.1007/s00132-022-04339-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is often associated with thoracic hypokyphosis or even lordosis. OBJECTIVES To analyze the influence of posterior correction and fusion in thoracic, structurally double-curved AIS. MATERIAL AND METHODS Out of 127 thoracic AIS (Lenke types 1 and 2) recorded prospectively, idiopathic double thoracic curve AIS were analyzed retrospectively. Surgery 2010-2019 with pedicle screw double rod systems in a scoliosis center. Follow-up (FU) at least 2 years. Frontal and sagittal angles (whole-spine radiographs, 2 planes): thoracic curve (MK), proximal-thoracic curve (PK) and lumbar curve (LK), thoracic kyphosis (TK), lumbar lordosis (LL). STATISTICAL ANALYSIS values as MW ± SD, students t‑test (significance a = 0.05), Pearson's correlation, sub-analysis with sagittal modifiers (-, N, +). RESULTS A total of 47 AIS-double thoracic curve were identified, mean FU 29.3 ± 12.2 months, mean age 14 ± 1.5 years. The mean correction (FU-preop) of MK was 67%, PK 53%, LK 73%, each significant, (p < 0.05). On average, TK (FU-preop) decreased by -6.5 ± 11.6° (p < 0.05), no significant change from FU (p = 0.6). TK (FU-preop) increased by 8.6 ± 5.0° (p < 0.05) in hypokyphotic cases, significantly decreased by -4.8 ± 9.6° in normokyphotic AIS and -25.3 ± 11.1° in hyperkyphotic cases, respectively (p < 0.05). In hypokyphosis: moderately strong correlation between correction PK (r = -0.5) and spontaneous correction LK (r = 0.8) (frontal plane) and change from pre- to postop TK (sagittal plane) (p < 0.05). Moderate correlation for hyperkyphosis: correction PK (r = -0.5) and postop TK (p < 0.05). No relevant correlations for normokyphosis. 17% had postop hypokyphosis, of which 0% had preop hypokyphosis. Rod diameter (5.5 mm vs. 6 mm) had no significant effect on TC. CONCLUSIONS Posterior instrumented correction and fusion (pedicle screw dual rod systems) can significantly correct both lateral curves in idiopathic double thoracic curves, although it is associated with an increased risk of postop thoracic hypokyphosis, especially in preoperatively normokyphotic patients.
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Affiliation(s)
- Clara Berlin
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland.
| | - Markus Quante
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland
| | - Henry Halm
- Wirbelsäulenchirurgie mit Skoliosezentrum, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Deutschland
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Berlin C, Quante M, Halm H. Influence of posterior instrumented correction with pedicle screw dual rod systems on thoracic kyphosis in Lenke 1 and 2 curves: minimum 2 years follow-up. 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 2023; 32:1187-1195. [PMID: 36856867 DOI: 10.1007/s00586-023-07617-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/13/2023] [Accepted: 02/18/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE Adolescent idiopathic scoliosis (AIS) often correspond with hypo thoracic kyphosis (TK) or even lordosis. The aim of this study was to analyze the influence of posterior instrumentation in thoracic AIS. METHODS Analysis of prospectively collected AIS-data with structural thoracic curves (Lenke type 1 & 2), operated 2010-2019 with pedicle screw dual rod systems in one scoliosis center. Follow-up (FU) minimum 24 months. Coronal and sagittal angles measured based on standing long-cassette-X-rays: thoracic major (MC), proximal thoracic (PC) and lumbar curve (LC), TK, lumbar lordosis (LL). STATISTICAL ANALYSIS values as mean ± SD, differences by student's t-test (significancy a = 0.05), Pearson's correlation, sub-analysis with sagittal modifier (-, N, +). RESULTS A total of 127 AIS could be identified (63% type 1, 37% type 2). Mean FU 32.2 ± 16.6 months, mean age 14 ± 1.5 years. Mean Correction of MC 73 ± 12%, PC 51 ± 17%, LC 69 ± 21% with a significantly better correction of PC in Lenke 2 curves(p < 0.05). On average, TK (FU-preop) decreased by -2.1 ± 12.1°(p < 0.05) in all AIS. Whereas TK in type 1 was unchanged (p = 0.9), TK significantly decreased by - 6.0 ± 12.7°(p < 0.05) in type 2. No significant difference in LL. TK in hypokyphotic cases increased by 9.5 ± 5.5°(p < 0.05), stayed almost unchanged (- 1.4 ± 9.1°,p = 0.2) in normokyphotic, decreased by - 17.2 ± 14.2°(p < 0.05) in hyperkyphotic cases. Only hypokyphotic cases had a moderately strong correlation between correction of LC (r = 0.6) and PC (r = - 0.4) (frontal plane) and change from pre- to postoperative TK (sagittal plane) (r = 0.6). No relevant correlations for normo- and hyperkyphotic AIS. Postoperative hypokyphosis was significantly more often in Lenke 2 (16.3% vs. 2.6%, p < 0.05). Rod diameter (5,5 mm versus 6 mm) had no significant influence. CONCLUSION Significant correction of hypo- and hyperkyphosis can be achieved with posterior spinal fusion (pedicle screw dual rod systems), whereas normokyphotic spines stay unchanged. However, Lenke 2 curves have a significantly higher risk for a postoperative thoracic hypokyphosis.
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Affiliation(s)
- Clara Berlin
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany.
| | - Markus Quante
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
| | - Henry Halm
- Spine Surgery with Scoliosis Center, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730, Neustadt in Holstein, Germany
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Thomas ES, Boyer N, Meyers A, Aziz H, Aminian A. Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment? 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 2023; 32:190-201. [PMID: 36357540 DOI: 10.1007/s00586-022-07437-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/17/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE To determine if the planned sagittal profile for thoracic kyphosis (TK) restoration was achieved after adolescent idiopathic scoliosis (AIS) surgery using a novel hybrid construct with apical double bands and precontoured patient-specific rods (PSR) made according to the detailed surgical plan for the desired sagittal plane. METHODS AIS patients with a Lenke type 1-4 primary right thoracic curve who underwent corrective surgery by a single surgeon and had minimum 24-month follow-up were analyzed retrospectively from a prospective database. All patients underwent simultaneous translation on two rods with apical double bands and PSR. Clinical outcomes in terms of sagittal 2D TK (T4-T12), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), PI-LL mismatch, rod angle, and rod deflection were compared between preoperative, planned, and 24-month data, while 3D apical rotation, 3D TK (T5-T12), sagittal thoracolumbar angle, degree of curvature at L1-L4 and L4-S1, proximal junctional angle, and distal junctional angle were compared at baseline and at 6 and 24 months postoperatively. SRS-22 questionnaire scores were obtained at baseline and 24 months postoperatively. RESULTS Forty-eight patients were included. Study patients had a median coronal thoracic curve of 62.7° preoperatively and 22.4° at 24-month follow-up (p < 0.001). Median TK gain was 6.5° for the entire cohort (n = 48) and 19.1° in the Lenke type 1 and 2 hypokyphotic subgroup (n = 14). Both groups had no significant changes between planned and 24-month TK (p = 0.068 and p = 0.943, respectively), rod angle (p = 0.776 and p = 0.548, respectively), or rod deflection (p = 0.661 and p = 0.850, respectively). For the overall study cohort, median LL gain was 7.0° (p < 0.001), 3D apical derotation was 10.7° (p < 0.001), and change in 3D TK was 36° (p < 0.001). No instance of proximal junctional kyphosis was observed. SRS-22 scores for pain, self-image, and satisfaction differed significantly between the preoperative and 24-month follow-up time-points. CONCLUSIONS With sagittal plane planning, desired TK, improved reciprocal changes in LL, and minimal changes in rod shape can be achieved in patients with AIS.
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Affiliation(s)
- Evelyn S Thomas
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA. .,Department of Orthopedic Surgery, Kettering Health Dayton, Dayton, OH, USA.
| | - Noah Boyer
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
| | - Andrew Meyers
- Department of Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA
| | - Hossein Aziz
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA.,Department of Orthopedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Afshin Aminian
- Department of Orthopedic Surgery, Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA
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Wang F, Chen K, Ji T, Ma Y, Huang H, Zhou P, Wei X, Chen Z, Bai Y. Do hypokyphotic adolescent idiopathic scoliosis patients treated with Ponte osteotomy obtain a better clinical efficacy? A preliminary retrospective study. J Orthop Surg Res 2022; 17:491. [PMID: 36384684 PMCID: PMC9670489 DOI: 10.1186/s13018-022-03390-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/06/2022] [Indexed: 11/17/2022] Open
Abstract
Study design A retrospective case–control study. Objective To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS).
Methods Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. Results The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. Conclusions Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.
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The Sagittal Plane in Spinal Fusion for Adolescent Idiopathic Scoliosis. J Am Acad Orthop Surg 2022; 30:e957-e967. [PMID: 35797683 DOI: 10.5435/jaaos-d-21-01060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/24/2022] [Indexed: 02/01/2023] Open
Abstract
Sagittal balance is widely recognized as the primary determinant of optimal outcomes in adult spinal deformity. In adolescent idiopathic scoliosis (AIS), coronal correction risks being obtained at the expense of sagittal malalignment after posterior spinal fusion. Apical lordosis, often underestimated on two-dimensional imaging, is the primary deforming factor in AIS. Failure to restore thoracic kyphosis and lumbar lordosis during posterior spinal fusion contributes to problematic early surgical complications, including proximal or distal junctional kyphosis and failure. Although adolescent patients often compensate for sagittal imbalance in the short-term and mid-term, late sequelae of iatrogenic sagittal imbalance include flatback syndrome, disk degeneration, cervical kyphosis, and late decompensation. Objective criteria using spinopelvic parameters and preoperative three-dimensional planning can guide sagittal plane correction during PSF for AIS. Technical caveats can help avoid sagittal plane complications, including instrumentation level selection, anchor type, and anatomic protection of adjacent levels. Other surgical techniques to optimize restoration of thoracic kyphosis include higher implant density, stiffer rod material, Ponte osteotomies, and deformity correction technique.
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Sakai D, Tanaka M, Takahashi J, Taniguchi Y, Schol J, Hiyama A, Misawa H, Kuraishi S, Oba H, Matsubayashi Y, Kato S, Sugawara R, Sato M, Watanabe M, Takeshita K. Cobalt-chromium versus titanium alloy rods for correction of adolescent idiopathic scoliosis based on 1-year follow-up: a multicenter randomized controlled clinical trial. J Neurosurg Spine 2021; 34:897-906. [PMID: 33740765 DOI: 10.3171/2020.9.spine201486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE For instrumented correction surgery for adolescent idiopathic scoliosis (AIS), surgeons are increasingly switching from titanium (Ti) alloy rods to stiffer cobalt-chromium (CoCr) rods. The authors conducted the first multicenter randomized controlled clinical trial to investigate whether these materials affect the outcomes in terms of spine correction and quality of life (QOL). This trial was registered at UMIN Clinical Trials Registry on September 3, 2012, under the identifier UMIN000008838 (level of evidence 1). METHODS Female AIS patients (Lenke types 1-3, patient age 10-19 years) were recruited at 5 Japanese institutions and randomized into two cohorts: 6.0-mm-diameter Ti rods were placed in one group, and 6.0-mm-diameter CoCr rods were placed in the other. Patients were followed up at 2 weeks and 3, 6, and 12 months with radiographic examination to quantify the sagittal and coronal correction (Cobb angle, thoracic kyphosis, rib hump, and apical vertebral rotation). Patients completed questionnaires (Scoliosis Research Society-22r, 12-Item Short-Form Health Survey, and Scoliosis Japanese Questionnaire-27) at 6 and 12 months to assess QOL. RESULTS A total of 69 AIS patients were randomized to the demographically similar Ti (n = 37) or CoCr (n = 32) cohort. Four adverse events were recorded, two in each cohort, but these were not related to the rod material. At the final follow-up, both Ti and CoCr cohorts showed significant improvement in spinal correction, including the Cobb angle, thoracic kyphosis, and rib hump size. The correction rates were 68.4% and 67.1% for the Ti and CoCr cohorts, respectively. No parameters differed significantly between the cohorts at any time. Survey data showed improved but similar outcomes in both cohorts. CONCLUSIONS Both treatments (Ti and CoCr) produced similar results and were efficient in engendering clinically significant spine corrections. Clinical trial registration no.: UMIN000008838 (UMIN Clinical Trials Registry).
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Affiliation(s)
- Daisuke Sakai
- 1Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Masato Tanaka
- 2Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama
| | - Jun Takahashi
- 3Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano
| | - Yuki Taniguchi
- 4Department of Orthopaedic Surgery, The University of Tokyo
| | - Jordy Schol
- 1Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Akihiko Hiyama
- 1Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Haruo Misawa
- 5Department of Orthopaedic Surgery, Okayama University School of Medicine, Okayama; and
| | - Shugo Kuraishi
- 3Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano
| | - Hiroki Oba
- 3Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano
| | | | - So Kato
- 4Department of Orthopaedic Surgery, The University of Tokyo
| | - Ryo Sugawara
- 6Department of Orthopaedics, Jichi Medical University, Tochigi, Japan
| | - Masato Sato
- 1Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
| | - Masahiko Watanabe
- 1Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Kanagawa
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Sakai D, Schol J, Hiyama A, Katoh H, Tanaka M, Sato M, Watanabe M. Simultaneous translation on two rods improves the correction and apex translocation in adolescent patients with hypokyphotic scoliosis. J Neurosurg Spine 2021; 34:597-607. [PMID: 33545675 DOI: 10.3171/2020.8.spine201232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objectives of this study were to apply the simultaneous translation on two rods (ST2R) maneuver involving rods contoured with a convexity at the desired thoracic kyphosis (TK) apex level and to assess the effects on the ability to support triplanar deformity corrections, including TK apex improvement, in patients with hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS Using retrospective analysis, the authors examined the digital records that included 2- to 4-week, 1-year, and 2-year postoperative radiographic follow-up data of female hypokyphotic (TK < 20°) AIS patients (Lenke type 1-3) treated with ST2R. The authors assessed the corrections of triplanar deformities by examining the main Cobb angle, TK, rib hump, apical vertebral rotation, Scoliosis Research Society 22-item questionnaire scores, and TK apex translocation. In order to better grasp the potential of ST2R, the outcomes were compared with those of a historical matched case-control cohort treated with a standard rod rotation (RR) maneuver. RESULTS Data were analyzed for 25 AIS patients treated with ST2R and 27 patients treated with RR. The ST2R group had significant improvements in the main Cobb angle and TK, reduction in the rib hump size at each time point, and a final correction rate of 72%. ST2R treatment significantly increased the kyphosis apex by an average of 2.2 levels. The correction rate was higher at each time point in the ST2R group than in the RR group. ST2R engendered favorable TK corrections, although the differences were nonsignificant, at 2 years compared with the RR group (p = 0.056). The TK apex location was significantly improved in the ST2R cohort (p < 0.001). At the 1-month follow-up, hypokyphosis was resolved in 92% of the ST2R cohort compared with 30% of the RR cohort. CONCLUSIONS Resolving hypokyphotic AIS remains challenging. The ST2R technique supported significant triplanar corrections, including TK apex translocation and restoration of hypokyphosis in most patients. Comparisons with the RR cohort require caution because of differences in the implant profile. However, ST2R significantly improved the coronal and sagittal corrections. It also allowed for distribution of correctional forces over two rod implants instead of one, which should decrease the risk of screw pullout and rod flattening. It is hoped that the description here of commercially available reducers used with the authors' surgical technique will encourage other clinicians to consider using the ST2R technique.
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Three-dimensional analysis of spinal deformity correction in adolescent idiopathic scoliosis: comparison of two distinct techniques. Childs Nerv Syst 2021; 37:555-560. [PMID: 32839853 DOI: 10.1007/s00381-020-04868-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare 3D postoperative deformity correction using two distinct commonly utilized techniques for the treatment of adolescent idiopathic scoliosis (AIS). METHODS AIS patients with major thoracic (Lenke 1-2) curves at two sites who underwent deformity correction via posterior spinal instrumented fusion using one of two distinct techniques were retrospectively reviewed. Patients were matched 1:1 between sites for Lenke type (95% Lenke 1) and follow-up time. The "band site" performed posteromedial translation using thoracic sublaminar bands and 5.5-mm rods. The "screw site" performed spine derotation using differential rod contouring with pedicle screws and 5.5-mm rods. 3D measures of deformity from spinal reconstructions were compared between sites. RESULTS Preoperatively, the groups had similar thoracic curve magnitudes (band, 55 ± 12° vs. screw, 52 ± 10°; p > 0.05); the "screw site" had less T5-T12 kyphosis (2 ± 14° vs. 7 ± 12°, p = 0.05) and greater thoracic apical rotation (- 19 ± 7° vs. - 14 ± 8°, p = 0.007). Postoperatively, the "screw site" had greater percent correction (61% vs. 76%, p < 0.001) and kyphosis restoration (p = 0.002). The groups achieved a similar amount of apical derotation (p = 0.9). The "band site" used cobalt chromium rods exclusively; the "screw site" used cobalt chromium (3%) and stainless steel (97%; p < 0.001). The "band site" performed significantly longer fusions. CONCLUSIONS Significant variations were found between two commonly utilized techniques in AIS surgery, including rod material, correction mechanisms, and fusion levels. Significantly, a greater 3D deformity correction of the coronal and sagittal planes was observed at the "screw site" compared to the "band site", but with no difference in axial plane correction.
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13
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Abstract
AIMS Significant correction of an adolescent idiopathic scoliosis in the coronal plane through a posterior approach is associated with hypokyphosis. Factors such as the magnitude of the preoperative coronal curve, the use of hooks, number of levels fused, preoperative kyphosis, screw density, and rod type have all been implicated. Maintaining the normal thoracic kyphosis is important as hypokyphosis is associated with proximal junctional failure (PJF) and early onset degeneration of the spine. The aim of this study was to determine if coronal correction per se was the most relevant factor in generating hypokyphosis. METHODS A total of 95 patients (87% female) with a median age of 14 years were included in our study. Pre- and postoperative radiographs were measured and the operative data including upper instrumented vertebra (UIV), lower instrumented vertebra (LIV), metal density, and thoracic flexibility noted. Further analysis of the post-surgical coronal outcome (group 1 < 60% correction and group 2 ≥ 60%) were studied for their association with the postoperative kyphosis in the sagittal plane using univariate and multivariate logistic regression. RESULTS Of the 95 patients, 71.6% (68) had a thoracic correction of > 60%. Most (97.8%) had metal density < 80%, while thoracic flexibility > 50% was found in 30.5% (29). Preoperative hypokyphosis (< 20°) was present in 25.3%. A postoperative thoracic hypokyphosis was four times more likely to occur in patients with thoracic correction ≥ 60% (odds ratio (OR) 4.08; p = 0.005), after adjusting for confounding variables. This association was not affected by metal density, thoracic flexibility, LIV, UIV, age, or sex. CONCLUSION Our study supports the 'essential lordosis' hypothesis of Roaf and Dickson, i.e. with a greater ability to translate the apical vertebra towards the midline, there is a commensurate lengthening of the anterior column due to the vertebral wedging. Cite this article: Bone Joint J 2020;102-B(4):513-518.
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Affiliation(s)
- Oded Hershkovich
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Areena D'Souza
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul R P Rushton
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Ifesemen S Onosi
- University of Nottingham, AR UK Centre for Sports Exercise and Osteoarthritis, Nottingham, UK
| | - Wai Weng Yoon
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
| | - Michael P Grevitt
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, UK
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Abstract
STUDY DESIGN A narrative review article study. OBJECTIVE The objective of this study was to highlight guiding principles and challenges faced with addressing sagittal alignment in patients with adult idiopathic scoliosis (AIS) and to discuss effective surgical strategies based upon our clinical experience. SUMMARY OF BACKGROUND DATA Previous research and guidelines for the treatment of AIS have focused on the correction of spinal deformity in the coronal and axial planes. Failure to address sagittal deformity has been associated with numerous adverse clinical outcomes. METHODS This is a review of the current body of literature and a description of the rod derotation surgical technique for correction in the sagittal plane. RESULTS Several studies have offered general goals for postoperative radiographic measures in the sagittal plane for patients with AIS. However, these guidelines are evolving as diagnostic and therapeutic modalities continue to improve. The rod derotation surgical technique through differential metal rods is one method to potentially address sagittal balance in AIS. CONCLUSIONS Alignment in the sagittal plane is a unique challenge facing surgeons for patients with AIS. Further research with an assessment of functional outcomes and longer follow-up is needed to more precisely guide treatment principles. LEVEL OF EVIDENCE Level IV.
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15
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Lastikka M, Oksanen H, Helenius L, Pajulo O, Helenius I. Comparison of Circular and Sagittal Reinforced Rod Options on Sagittal Balance Restoration in Adolescents Undergoing Pedicle Screw Instrumentation for Idiopathic Scoliosis. World Neurosurg 2019; 127:e1020-e1025. [PMID: 30995548 DOI: 10.1016/j.wneu.2019.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pedicle screw instrumentation is widely used for spinal deformity correction and fusion in adolescents for idiopathic scoliosis. The goal is to achieve and sustain good alignment in all 3 planes. We compared 2 different cobalt-chromium (CoCr) rod designs with different stiffnesses with regard to the restoration of coronal and sagittal balance in adolescents operated on for idiopathic scoliosis. MATERIAL AND METHODS A prospective comparative study was made of 90 consecutive adolescents, mean age (standard deviation) 15.6 years (2.1 years), with idiopathic scoliosis who underwent posterior spinal fusion by the use of bilateral segmental pedicle screw instrumentation (PSI) with 6.0 Co-Cr rods. Fifty-four adolescents (43 girls) were operated on by the use of circular rods and 36 (27 girls) by the use of sagittal reinforced rods, with a 2-year follow-up. RESULTS Preoperative major coronal curves were similar and at 2 years: 11° (5.0) and 17° (7.2) with correction percentages of 78% (10) and 69% (12) in the circular and reinforced rod groups (P < 0.01). Thoracic kyphosis at 2 years measured 16° (7) and 21° (6) in the circular and reinforced rod groups (P < 0.01). The number of patients with hypokyphosis was lower in the reinforced rod group at 2 years (P = 0.02). In the reinforced rod group, there was a negative correlation between coronal correction and thoracic kyphosis (r = -0.52, P < 0.01). CONCLUSIONS Both circular and sagittal reinforced 6.0-mm CoCr rods provide adequate coronal correction for adolescents with idiopathic scoliosis. The use of sagittal reinforced rods provided better thoracic kyphosis restoration and a lower risk for postoperative hypokyphosis.
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Affiliation(s)
- Markus Lastikka
- Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland.
| | - Hanna Oksanen
- Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland
| | - Linda Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland; Department of Anaesthesia and Critical Care, University of Turku, Turku University Hospital, Turku, Finland
| | - Olli Pajulo
- Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland
| | - Ilkka Helenius
- Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland
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Sagittal Spinopelvic Alignment After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2019; 44:41-52. [PMID: 29889799 DOI: 10.1097/brs.0000000000002736] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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 The aim of this study was to determine the differences in the sagittal spinopelvic parameters between the nonscoliotic controls, preoperative, and different time points postoperative in Lenke 1 and 5 adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The postoperative changes in the sagittal profile of Lenke 1 and 5 AIS at varying time points after posterior spinal fusion (PSF) has not been rigorously demonstrated; studies performed have had conflicting results. METHODS Sagittal spinal and pelvic parameters, T5-T12 thoracic kyphosis (TK), L1-S1 lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and sagittal vertical axis (SVA), for Lenke 1 and 5 preoperatively, at immediate, less than 2-year, and more than 2-year postoperatively, and for nonscoliotic adolescents were searched. Differences in the sagittal spinopelvic parameters between preoperative and the follow-ups and between the nonscoliotic and pre- and postoperative AIS subtypes were calculated through meta-analysis. RESULTS A total of 22 studies on Lenke1 (1229 patients), 13 studies on Lenke5 (437 patients), and 18 studies on controls (1636 patients) were reviewed. Among all the measured variables, only PI in Lenke1 was significantly different between the final follow-up and controls, P < 0.05. In Lenke 1, SVA was significantly more anterior at the immediate postoperative than preoperative, but continued moving posteriorly up to 2-year postoperative resulting in no significant difference in the SVA position between the final follow-up and preoperative, P > 0.05. In Lenke 5, SVA was significantly more posterior at the immediate postoperative and more anterior at the final follow-up than the preoperative measurements, p < 0.05. CONCLUSIONS Continuous changes in the sagittal spinal parameters should be expected after PSF. Normalization of the sagittal spinal parameters appears to be the rule after PSF, and watchful waiting appears to be appropriate in this population when viewing the lateral X-ray postoperatively. LEVEL OF EVIDENCE 4.
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17
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Ohrt-Nissen S, Dragsted C, Dahl B, Ferguson JAI, Gehrchen M. Improved restoration of thoracic kyphosis using a rod construct with differentiated rigidity in the surgical treatment of adolescent idiopathic scoliosis. Neurosurg Focus 2018; 43:E6. [PMID: 28965450 DOI: 10.3171/2017.7.focus17351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to compare postoperative sagittal alignment among 3 rod constructs with different rigidity profiles. METHODS This was a dual-center retrospective cohort study involving 2 consecutive cohorts in which patients were surgically treated for adolescent idiopathic scoliosis. Lenke Type 5 curves were excluded. Patients were operated on with all-pedicle screw instrumentation using 3 different rod constructs. The first group was operated on using a hybrid construct (HC) consisting of a normal circular rod on the convex side and a beam-like rod (BR) on the concave side. The second group was operated on with a standard construct (SC) using bilateral BRs in the full length of the fusion. The third group was operated on with a modified construct (MC). The modified rods have a beam-like shape in the caudal portion, but in the cranial 2 or 3 fusion levels the rod transitions to a circular shape with a smaller anteroposterior diameter. Radiographs were analyzed preoperatively and at the first postoperative follow-up (range 1-8 weeks). The primary outcome was pre- to postoperative change in thoracic kyphosis (TK), and the secondary outcome was the ability to achieve postoperative TK within the normal range. RESULTS The HC, SC, and MC groups included 23, 70, and 46 patients, respectively. The 3 groups did not differ significantly in preoperative demographic or radiographic parameters. The mean ± standard deviation of the preoperative main curve was 60.7° ± 12.6°, and the mean of curve correction was 62.9% ± 10.4% with no significant difference among groups (p ≥ 0.680). The groups did not differ significantly in coronal balance or proximal or thoracolumbar curve correction (p ≥ 0.189). Mean postoperative TK was 23.1° ± 6.3°, 19.6° ± 7.6°, and 23.4° ± 6.9° in the HC, SC and MC groups, respectively (p = 0.013), and the mean change in TK was -3.5° ± 11.3°, -7.1° ± 11.6°, and 0.1° ± 10.9°, respectively (p = 0.005). The MC group had significantly higher postoperative TK and less loss of TK compared with the SC group (p ≤ 0.018). Postoperative TK ≤ 10° was found in 12 patients (17%) in the SC group, 1 patient (5%) in the HC group, and 1 patient (2%) in the MC group (p = 0.021). There were no differences in proximal alignment, thoracolumbar alignment, or sagittal vertical axis (p ≥ 0.249). Lumbar lordosis was 58.9° ± 11.2° in the HC group versus 52.0° ± 1.3° and 55.0° ± 11.0° and the SC and MC groups, respectively (p = 0.040). CONCLUSIONS In the 3 rod constructs with different rigidity profiles, significantly better restoration of kyphosis was achieved with the use of bilateral modified rods compared with bilateral standard rods. In the MC and HC groups, the rate of severe postoperative hypokyphosis was significantly lower than in the SC group. This is the first study to describe the clinical use of a rod with a reduced proximal diameter and show marked radiographic improvement in sagittal alignment.
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Affiliation(s)
- Søren Ohrt-Nissen
- Department of Orthopaedic Surgery, Spine Unit, University Hospital of Copenhagen, Denmark
| | - Casper Dragsted
- Department of Orthopaedic Surgery, Spine Unit, University Hospital of Copenhagen, Denmark
| | - Benny Dahl
- Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital, Houston, Texas; and
| | | | - Martin Gehrchen
- Department of Orthopaedic Surgery, Spine Unit, University Hospital of Copenhagen, Denmark
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Tambe AD, Panikkar SJ, Millner PA, Tsirikos AI. Current concepts in the surgical management of adolescent idiopathic scoliosis. Bone Joint J 2018; 100-B:415-424. [DOI: 10.1302/0301-620x.100b4.bjj-2017-0846.r2] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a complex 3D deformity of the spine. Its prevalence is between 2% and 3% in the general population, with almost 10% of patients requiring some form of treatment and up to 0.1% undergoing surgery. The cosmetic aspect of the deformity is the biggest concern to the patient and is often accompanied by psychosocial distress. In addition, severe curves can cause cardiopulmonary distress. With proven benefits from surgery, the aims of treatment are to improve the cosmetic and functional outcomes. Obtaining correction in the coronal plane is not the only important endpoint anymore. With better understanding of spinal biomechanics and the long-term effects of multiplanar imbalance, we now know that sagittal balance is equally, if not more, important. Better correction of deformities has also been facilitated by an improvement in the design of implants and a better understanding of metallurgy. Understanding the unique character of each deformity is important. In addition, using the most appropriate implant and applying all the principles of correction in a bespoke manner is important to achieve optimum correction. In this article, we review the current concepts in AIS surgery. Cite this article: Bone Joint J 2018;100-B:415–24.
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Affiliation(s)
- A. D. Tambe
- Royal Manchester Children’s Hospital & Salford Royal Foundation Trust, Upper Brook Street, Manchester M13 9WL, UK
| | - S. J. Panikkar
- Salford Royal Foundation Trust, Stott
Lane, Salford M6 8HD, UK
| | - P. A. Millner
- Leeds Teaching Hospitals, Great
George Street, Leeds LS1 3EX, UK
| | - A. I. Tsirikos
- Edinburgh Royal Hospital for Sick Children, Sciennes
Road, Edinburgh EH9 1LF, UK
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Luo M, Jiang H, Wang W, Li N, Shen M, Li P, Xu G, Xia L. Influence of screw density on thoracic kyphosis restoration in hypokyphotic adolescent idiopathic scoliosis. BMC Musculoskelet Disord 2017; 18:526. [PMID: 29237433 PMCID: PMC5729421 DOI: 10.1186/s12891-017-1877-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies have reported that rod composition and diameter, as well as the correction technique are key factors associated with thoracic kyphosis (TK) restoration. However, few study has analyzed the correlation between screw density and TK restoration in hypokyphotic adolescent idiopathic scoliosis (AIS). Methods Fifty-seven thoracic AIS patients with preoperative TK < 10° treated with all pedicle screw fixation with a minimum 2-year follow-up were recruited. Preoperative and postoperative radiographic measurements, and information of posterior instrumentation were reviewed. Pearson and Spearman correlation coefficient analysis were used to assess relationships between change in TK and number of variables. Then, the included patients were classified into two groups (Group 1: postoperative TK ≥ 20°; Group 2: postoperative TK < 20°) to evaluate the influence factors of TK restoration. Results The average preoperative TK was 4.75°, which was significantly restored to 17.30° (P < 0.001). Significant correlations were found between change in TK and flexibility of major thoracic curve (r = 0.357, P = 0.006), preoperative TK (r = −0.408, P = 0.002), and screw density of concave side (r = 0.306, P = 0.021), respectively. In the subgroup comparison, 17 patients (29.8%) maintain the postoperative TK ≥ 20°, increased flexibility of major thoracic curve (P < 0.001), screw number of concave side (P = 0. 029), and cobalt chromium rods (P = 0.041) were found in the group of postoperative TK ≥ 20°. Conclusions TK restoration remains a challenge for AIS patients with hypokyphosis, especially for the poor flexibility ones. Except for thicker and cobalt chromium rods, screw density of concave side might be another positive predictor of restoring normal kyphosis, which provides a stronger corrective force on the sagittal plane with more pedicle screws.
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Affiliation(s)
- Ming Luo
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Honghui Jiang
- Department of Orthopaedic Surgery, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Wengang Wang
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Ning Li
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Mingkui Shen
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Peng Li
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Genzhong Xu
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China
| | - Lei Xia
- Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, People's Republic of China.
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Lonner BS, Toombs CS, Paul JC, Shah SA, Shufflebarger HL, Flynn JM, Newton PO. Resource Utilization in Adolescent Idiopathic Scoliosis Surgery: Is There Opportunity for Standardization? Spine Deform 2017; 5:166-171. [PMID: 28449959 DOI: 10.1016/j.jspd.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 11/23/2016] [Accepted: 01/03/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Recent healthcare reforms have raised the importance of cost and value in the management of disease. Value is a function of benefit and cost. Understanding variability in resources utilized by individual surgeons to achieve similar outcomes may provide an opportunity for cutting costs though greater standardization. The purpose of this study is to evaluate differences in use of implants and hospital resources among surgeons performing adolescent idiopathic scoliosis (AIS) surgery. METHODS A multicenter prospective AIS operative database was queried. Patients were matched for Lenke curve type and curve magnitude, resulting in 5 surgeons and 35 matched groups (N = 175). Mean patient age was 14.9 years and curve magnitude 50°. Parameters of interest were compared between surgeons via ANOVA and Bonferroni pairwise comparison. RESULTS There was no significant difference in percentage curve correction or levels fused between surgeons. Significant differences between surgeons were found for percentage posterior approach, operative time, length of stay (LOS), estimated blood loss (EBL), cell saver transfused, rod material, screw density, number of screws, use of antifibrinolytics, and cessation of intravenous analgesics. Despite differences in EBL and cell saver transfused, there were no differences in allogenic blood (blood bank) use. CONCLUSION Significant variability in resource utilization was noted between surgeons performing AIS operations, although radiographic results were uniform. Standardization of resource utilization and cost containment opportunities include implant usage, rod material, LOS, and transition to oral analgesics, as these factors are the largest contributors to cost in AIS surgery.
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Affiliation(s)
- Baron S Lonner
- Department of Orthopaedic Surgery, Mount Sinai-Beth Israel Medical Center, Scoliosis and Spine Associates, 820 Second Avenue, New York, NY 10017, USA.
| | - Courtney S Toombs
- New York University School of Medicine, Scoliosis and Spine Associates, 820 Second Avenue, New York, NY 10017, USA
| | - Justin C Paul
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, Scoliosis and Spine Associates, 820 Second Avenue, New York, NY 10017, USA
| | - Suken A Shah
- Department of Orthopaedic Surgery, AI Du Pont Hospital, Nemours Children's Clinic - Wilmington of the Nemours Foundation, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Harry L Shufflebarger
- Department of Orthopaedic Surgery, Miami Children's Hospital, Nicklaus Children's Orthopedic Spine Center, 3100 SW 62 Avenue NE Wing #108, Miami, FL 33155, USA
| | - John M Flynn
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Division of Orthopedic Surgery, 2nd Floor Wood Building, 34th St. & Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Peter O Newton
- Department of Orthopaedic Surgery, Rady Children's Hospital, Pediatric Orthopedic & Scoliosis Ctr, 3030 Children's Way #410, San Diego, CA 92123, USA
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Le Navéaux F, Aubin CE, Parent S, O. Newton P, Labelle H. 3D rod shape changes in adolescent idiopathic scoliosis instrumentation: how much does it impact correction? 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 2017; 26:1676-1683. [DOI: 10.1007/s00586-017-4958-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 11/24/2016] [Accepted: 01/15/2017] [Indexed: 11/30/2022]
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Pizones J, Núñez-Medina A, Sánchez-Mariscal F, Zúñiga L, Izquierdo E. Thoracic sagittal plane variations between patients with thoracic adolescent idiopathic scoliosis and healthy adolescents. 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 2016; 25:3095-3103. [PMID: 26821145 DOI: 10.1007/s00586-016-4400-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the sagittal thoracic parameters of different types of progressive thoracic adolescent idiopathic scoliosis (AIS) patients and compare them with healthy adolescents. METHODS 115 AIS patients with main thoracic curves (Cobb: 59.4 ± 12.7) were prospectively compared with 116 healthy adolescents. The AIS and control (C) groups were homogeneous in terms of age and gender. Standing sagittal radiographs were analyzed for differences in T5-T12 kyphosis, T5-T8 and T9-T12 segmental kyphosis, the change between these two angles, and the double rib contour sign. Statistical analyses were performed using the χ 2, one-way ANOVA, Mann-Whitney U and Student's t tests. RESULTS The sagittal parameters of Lenke 1 curves did not differ from healthy adolescents (T5-T8: 17.1 ± 10 vs C: 16 ± 7; T9-T12: 6.3 ± 7 vs C: 7.9 ± 5; T5-T12: 23.9 ± 14 vs C: 23.9 ± 8). Compared with the controls, Lenke type 3 curves were globally more hypokyphotic (T5-T12: 18.9 ± 12 vs C: 23.9 ± 8, P = 0.027) due to a "lordosis" of the lower thoracic segment (T9-T12: 0.9 ± 10 vs C: 7.9 ± 5, P = 0.001). Type 2 curves tended to exhibit more pronounced upper thoracic kyphosis (T5-T8: 20.7 ± 12 vs C: 16 ± 7). Both types 2 and 3 require a marked TK changes in the transition between the upper and lower thoracic segments to compensate for global (T5-T12) kyphosis. CONCLUSIONS In this 2D analysis of moderate AIS, Lenke 1 curves exhibited normal thoracic sagittal parameters, which brings into question the effect of lordosis on the development of single thoracic curves. Lenke 3 curves exhibited lower thoracic segmental hypokyphosis, and the type 2 showed upper segmental hyperkyphosis. These results should be considered when planning a surgical strategy.
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Affiliation(s)
- Javier Pizones
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain.
| | - Alberto Núñez-Medina
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain
| | - Felisa Sánchez-Mariscal
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain
| | - Lorenzo Zúñiga
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain
| | - Enrique Izquierdo
- Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain
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Pizones J, Sánchez-Mariscal F, Zúñiga L, Izquierdo E. Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers. 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 2015; 24:1540-6. [DOI: 10.1007/s00586-014-3749-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022]
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Bartley CE, Bastrom TP, Newton PO. Blood Loss Reduction During Surgical Correction of Adolescent Idiopathic Scoliosis Utilizing an Ultrasonic Bone Scalpel. Spine Deform 2014; 2:285-290. [PMID: 27927349 DOI: 10.1016/j.jspd.2014.03.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 03/21/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVES To evaluate blood loss associated with posterior spinal fusion in adolescent idiopathic scoliosis patients performed with and without the use of an ultrasonic bone scalpel (UBS). SUMMARY OF BACKGROUND INFORMATION After using an ultrasonic-powered bone-cutting device with recent Food and Drug Administration approval for use in the spine, the authors perceived a reduction in bone bleeding associated with the cut boney surfaces. METHODS The first 20 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion using the UBS by a single surgeon were compared with 2 control groups: 1) the 20 most recent prior cases of the same surgeon before beginning use of the bone scalpel; and 2) 20 cases of the same surgeon before using the bone scalpel matched based on Cobb angle magnitudes. Both cases and controls had Ponte-type posterior apical releases; none had an anterior procedure. Patient demographic and surgical data were analyzed using analysis of variance (p < .05). RESULTS Preoperatively, the UBS group was similar to both control groups in terms of primary and secondary curve magnitudes, number of levels fused, number of levels with Ponte release, antifibrinolytic use, and patient age (p > .05). The UBS group had significantly less estimated blood loss (EBL) (550 ± 359 mL), Cell Saver blood transfused (94 ± 146 mL), and EBL per level fused (48 ± 30 mL) than the most recent controls (EBL: 799 ± 376 mL; Cell Saver: 184 ± 122 mL; EBL/level fused: 72 ± 28 mL) and Cobb-matched controls (EBL: 886 ± 383 mL; Cell Saver: 198 ± 115 mL; EBL/level fused: 78 ± 30 mL) (p < .05). Surgical times were equivalent and there were no dural tears in any group. CONCLUSIONS The use of an ultrasonic bone scalpel to perform the bone cuts associated with facetectomies and apical Ponte-type posterior releases resulted in significantly less bleeding compared with cuts made with standard osteotomes and rongeurs, limiting overall blood loss by 30% to 40%.
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Affiliation(s)
- Carrie E Bartley
- Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA
| | - Tracey P Bastrom
- Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA
| | - Peter O Newton
- Rady Children's Hospital, 3020 Children's Way, Suite 410, San Diego, CA 92123, USA.
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Clement JL, Chau E, Geoffray A, Suisse G. Restoration of thoracic kyphosis by simultaneous translation on two rods for adolescent 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 2014; 23 Suppl 4:S438-45. [PMID: 24854726 DOI: 10.1007/s00586-014-3340-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 04/24/2014] [Accepted: 04/24/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Sagittal and axial corrections of the three-dimensional deformity characteristic of scoliosis remain challenging. MATERIALS AND METHOD The author developed a new technique for scoliosis correction consisting of the translation of vertebrae simultaneously towards two rods, which are pre-bent to the correct sagittal profile. Using two rods ensures both reduction and stabilization of the curve. The system includes stable anchorages with polyaxial-threaded extensions that connect to the rods. Deformity reduction is done by tightening nuts simultaneously and progressively on the two rods. Results demonstrate the efficiency of this technique to achieve normal thoracic kyphosis (>20°) in all 99 patients, with a mean gain of 19° of thoracic kyphosis in hypokyphotic cases. Coronal correction was 70-80% with a vertebral rotation gain of 40% where derotation connectors were used. CONCLUSIONS In a large consecutive series of patients, this new technique allows to achieve a good 3D correction of the scoliosis.
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Affiliation(s)
- Jean-Luc Clement
- Department of Paediatric Orthopaedic Surgery and Scoliosis Surgery, Hôpital Pédiatrique Nice CHU Lenval, 57 avenue de la Californie, 06200, Nice, France,
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