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Huang Y, Zhu C, Wang Y, Feng G, Liu L. A Novel Deformity Correction Manipulation System for Better Correction of Large Thoracic Scoliosis. Orthop Surg 2024. [PMID: 39072994 DOI: 10.1111/os.14169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE Treating patients with large thoracic scoliosis (between 70° and 100°) poses technical challenges, particularly with traditional correction techniques (TCT). To address this, we developed a novel deformity correction manipulation system (DCMS) aimed at reducing surgical complexity and trauma. This study aims to assess the safety and effectiveness of DCMS in treating large thoracic scoliosis. METHODS From January 2016 to June 2021, 76 patients with large thoracic scoliosis were included in this retrospective study. The patients were divided into two groups: DCMS (n = 34) and TCT (n = 42). Basic patient data including age at surgery, sex, etiology, Risser sign, flexibility of the main thoracic curve, instrumented levels, number of screws, duration of hospital stay, and follow-up time were collected and analyzed. Radiographic and clinical outcomes, as measured by various radiographic parameters and Scoliosis Research Society-30 (SRS-30) scores, were retrospectively analyzed and compared between the two groups. Adverse events were also documented. Statistical analyses were performed using two-tailed independent t-tests, chi-square tests, and Fisher's exact test. RESULTS The DCMS group exhibited significantly shorter operative times, reduced blood loss, and shorter hospital stays compared to the TCT group. However, there were no significant differences between the two groups in terms of age at surgery, sex, etiology, Risser sign, flexibility of the main curve, instrumented levels, number of screws, and follow-up time. While preoperative major curves were statistically similar between the two groups, the DCMS group achieved a superior correction rate compared to the TCT group (74.2% ± 8.8% vs 68.1% ± 10.5%). No significant differences were observed in other radiographic parameters, SRS-30 scores, or the incidence of adverse events. CONCLUSION The application of DCMS resulted in shorter operative times, reduced blood loss, shorter hospital stays, and greater curve correction compared to TCT. DCMS proves to be a safe and effective technique for treating large thoracic curves.
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Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yongliang Wang
- Department of Orthopedic Surgery, Pangang Group General Hospital, Panzhihua, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Solla F, Ilharreborde B, Clément JL, Rose EO, Monticone M, Bertoncelli CM, Rampal V. Patient-Specific Surgical Correction of Adolescent Idiopathic Scoliosis: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:106. [PMID: 38255419 PMCID: PMC10814112 DOI: 10.3390/children11010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/03/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.
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Affiliation(s)
- Federico Solla
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Brice Ilharreborde
- Paediatric Orthopaedic Unit, Hôpital Robert Debré, AP-HP, 75019 Paris, France;
| | - Jean-Luc Clément
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Emma O. Rose
- Krieger School of Arts & Sciences, Homewood Campus, John Hopkins University, Baltimore, MD 21218, USA
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Carlo M. Bertoncelli
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
| | - Virginie Rampal
- Paediatric Orthopaedic Unit, Lenval Foundation, 57, Avenue de la Californie, 06200 Nice, France; (J.-L.C.); (C.M.B.); (V.R.)
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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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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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Shi J, Ordway NR, Sun MH, Albanese SA, Lavelle WF. The effectiveness of pre-contoured titanium alloy rods in inducing thoracic kyphosis after sequential spinal releases in an in vitro biomechanical model. Front Surg 2023; 10:1064037. [PMID: 37206351 PMCID: PMC10189140 DOI: 10.3389/fsurg.2023.1064037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose Evaluate the ability of pre-contoured rods to induce thoracic kyphosis (TK) in human cadaveric spines and determine the effectiveness of sequential surgical adolescent idiopathic scoliosis (AIS) release procedures. Methods Six thoracolumbar (T3-L2) spine specimens were instrumented with pedicle screws bilaterally (T4-T12). Over correction using pre-contoured rods was performed for intact condition and Cobb angle was measured. Rod radius of curvature (RoC) was measured pre- and post-reduction. The process was repeated following sequential release procedures of (1) interspinous and supraspinous ligaments (ISL); (2) ligamentum flavum; (3) Ponte osteotomy; (4) posterior longitudinal ligament (PLL); and (5) transforaminal discectomy. Cobb measurements determined the effective contribution of release on TK and RoC data displayed effects of reduction to the rods. Results The intact TK (T4-12) was 38.0° and increased to 51.7° with rod reduction and over correction. Each release resulted in 5°-7°of additional kyphosis; the largest releases were ISL and PLL. All releases resulted in significant increases in kyphosis compared to intact with rod reduction and over correction. Regionally, kyphosis increased ∼2° for each region following successive releases. Comparing RoC before and after reduction showed significant 6° loss in rod curvature independent of release type. Conclusion Kyphosis increased in the thoracic spine using pre-contoured and over corrected rods. Subsequent posterior releases provided a substantial, meaningful clinical change in the ability to induce additional kyphosis. Regardless of the number of releases, the ability of the rods to induce and over correct kyphosis was reduced following reduction.
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Curve Characteristics and Surgical Outcomes in Scoliosis Associated With Childhood Sternotomy or Thoracotomy. J Pediatr Orthop 2022; 42:558-563. [PMID: 36017932 DOI: 10.1097/bpo.0000000000002229] [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: 02/07/2023]
Abstract
BACKGROUND The purpose of this study is to describe curve characteristics and postoperative outcomes in patients undergoing spinal fusion (SF) to treat thoracogenic scoliosis related to sternotomy and/or thoracotomy as a growing child. METHODS A retrospective review of electronic medical records of all patients with Post-Chest Incision scoliosis treated with SF was performed at 2 tertiary care pediatric institutions over a 19-year period. Curve characteristics, inpatient, and outpatient postoperative outcomes are reported. RESULTS Thirty-nine patients (62% female) were identified. Eighteen had sternotomy alone, 14 had thoracotomy alone, and 7 had both. Mean age at the time of first chest wall surgery was 2.5 years (range: 1.0 d to 14.2 y). Eighty-five percent of patients had a main thoracic curve (mean major curve angle 72 degrees, range: 40 to 116 degrees) and 15% had a main lumbar curve (mean major curve angle 76 degrees, range: 59 to 83 degrees). Mean thoracic kyphosis was 40 degrees (range: 4 to 84 degrees). Mean age at the time of SF was 14 years (range: 8.2 to 19.9 y). Thirty-six patients had posterior fusions and 3 had combined anterior/posterior. Mean coronal curve correction measured at the first postoperative encounter was 53% (range: 9% to 78%). There were 5 (13%) neuromonitoring alerts and 2 (5%) patients with transient neurological deficits. Mean length of hospital stay was 9±13 days. At an average follow-up time of 3.1±2.4 years, 17 complications (10 medical and 7 surgical) were noted in 9 patients for an overall complication rate of 23%. There was 1 spinal reoperation in the cohort. 2/17 (12%) complications were Clavien-Dindo-Sink class III and 5/17 (29%) were class IV. CONCLUSION Kyphotic thoracic curves predominate in patients with Post-Chest Incision scoliosis undergoing SF. Although good coronal and sagittal plane deformity can be expected after a fusion procedure, postoperative complications are not uncommon in medically complex patients, often necessitating longer postoperative stays. LEVEL OF EVIDENCE Level III.
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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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