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Boachie-Adjei O, Duah HO, Sackeyfio A, Yankey KP, Lenke LG, Sponseller PD, Samdani AF, Sucato DJ, Sides BA, Newton PO, Shah SA, Akoto H, Gupta MC. Surgical outcomes of severe spinal deformities exceeding 100° or treated by vertebral column resection (VCR). Does implant density matter?: an observational study of deformity groupings. Spine Deform 2022; 10:595-606. [PMID: 35305251 DOI: 10.1007/s43390-021-00460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/11/2021] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Prospective multicenter international observational study. OBJECTIVE To investigate the effect of implant density on clinical outcomes in complex pediatric spine reconstruction. Implant density in spine deformity surgery has been a subject of much debate with some authors advocating higher density for better correction. Few studies have looked at the effect of implant density on severe curves > 100 deg or treated with vertebral column resection (VCR). METHODS 250/311 pts with 2-year f/u enrolled in the FOX pediatric database from 17 international sites were queried for the impact of implant density and surgical outcomes. Patients were grouped into three implant density categories for comparative analysis Group 1 (density ≤ 1), Group 2 (1 < density < 1.5) and Group 3 (density; 1.5-2). RESULTS 250 pts: 47 (Grp1)/99 (Grp2) /104 (Grp3); Pre-op age and etiology and curve types were similar in all groups, but body mass index (BMI) was higher in Grp3. Grps 1 and 2 had significantly higher sagittal deformity angular ratio (S-DAR) compared to Grp 3 (p < 0.001). Pre-op Halo Gravity Traction (HGT) was used in 55.3%/44.4%/31.7%, p = 0.017; Grp1/Grp2/Grp3, respectively. Average duration of surgery (min) was higher in Grp3 relative to Grp1 only: 352.5/456.5/515.0, p = 0.0029. Blood loss was similar in all Grps. Rate of VCR, PSO and SPO was similar in all Grps. Pre-op Coronal Cobb avg 96.1/83.6/88.6, p = 0.2342, attained similar correction after HGT (24.6%/27.2%/23.2%, p = 0.4864. Coronal Cobb corrections at 2-year follow-up (FU) were (37.1%/40.3%/53.5%, p = 0.0004). Pre-op sagittal Cobb was (105.4/101.9/75.9, p < 0.01.), achieved similar %correction in HGT (19.1%/22.3%/22.5%, p = 0.6851) and at 2-year FU (39.6%/41.4%/29.8%, p = 0.1916). After adjusting for C-DAR, S-DAR, pre-op coronal and sagittal Cobb, etiology, curve types, age, BMI and number of rods in multivariate analysis, the odds of developing post-operative implant complication was 11 times greater in group 1 compared to group 3 (OR = 11.17,95% CI 2.34-53.32). There was significant improvement in SRS scores in all Grps at 2-year FU. CONCLUSION Although higher implant density was observed to be associated with greater curve correction and lower rates of post-operative implant-related complication and revision in heterogeneous case groups, the results may not imply causality of implant density on the outcomes in severe pediatric spine reconstruction.
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Affiliation(s)
| | - Henry Ofori Duah
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | - Arthur Sackeyfio
- FOCOS Orthopaedic Hospital, No 8 Teshie Street Pantang, Accra, Ghana
| | | | | | | | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | | | - Brenda A Sides
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Suken A Shah
- Spine and Scoliosis Center, Nemours/Alfred I. du Pont Pediatrics, Wilmington, DE, USA
| | | | - Munish C Gupta
- Department of Orthopedics, Washington University School of Medicine, St. Louis, MO, USA
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Kalidindi KKV, Sath S, Sharma J, Chhabra HS. Management of severe rigid scoliosis by total awake correction utilizing differential distraction and in situ stabilization. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wright DN, Kieser DC, Cunningham G, Liantis P, Hunt R, Ember TM, Kumar MM, Pereira EAC, Lucas JD. Halo Femoral Traction for 1 Week Between Staged Anterior and Posterior Fusion Surgeries for Severe Adolescent Scoliosis Is Effective and Safe. World Neurosurg 2020; 141:e998-e1004. [PMID: 32585379 DOI: 10.1016/j.wneu.2020.06.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/12/2020] [Accepted: 06/14/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report the outcomes of halo femoral traction (HFT) used for 1 week between anterior release and definitive posterior fusion in adolescents with severe rigid scoliosis. METHODS A retrospective single-center review of 22 consecutive patients (mean age at surgery, 14.1 years; range, 10.5-18.2 years; 17 girls) with severe, rigid scoliosis treated with anterior release, followed by HFT for 7 days prior to posterior instrumented fusion. Cobb angles were measured preoperatively, 1 week after anterior release and traction, after posterior fusion, and at a minimum 2-year follow-up. Complications were recorded. RESULTS Mean preoperative Cobb angle was 97° (range, 80°-118°), correcting to 52° with anterior release and HFT and 31° after posterior fusion. This equated to a 68% deformity correction and was maintained at final follow-up. Three traction-related complications were experienced, including 1 case of neck pain and 2 cases of brachial plexopathy that resolved with traction weight reduction. CONCLUSIONS Three-staged deformity correction using HFT for 1 week only offers gradual correction of the spine over sufficient time to optimize deformity correction yet minimizes neurologic dysfunction.
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Affiliation(s)
- Daniel N Wright
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - David C Kieser
- Department of Orthopaedics and Musculoskeletal Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand.
| | - Gregory Cunningham
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Panagiotis Liantis
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Rachel Hunt
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Thomas M Ember
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Mohit M Kumar
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
| | - Erlick A C Pereira
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England; Academic Neurosurgery Unit, St George's Hospital, University of London, London, England
| | - Jonathan D Lucas
- Spinal Unit, Department of Orthopaedic Surgery, Guy's and St Thomas' NHS Foundation Trust and Evelina London Children's Hospital, London, England
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Severe Rigid Scoliosis: Review of Management Strategies and Role of Spinal Osteotomies. Asian Spine J 2017; 11:494-503. [PMID: 28670419 PMCID: PMC5481606 DOI: 10.4184/asj.2017.11.3.494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/14/2016] [Accepted: 01/04/2017] [Indexed: 11/08/2022] Open
Abstract
Severe rigid curves pose a considerable challenge to the treating spine surgeon. In our practice, approximately 30%–40% of patients with scoliosis present late with severe rigid scoliosis (>90° and <30% correction on bending films). Controversy still exists with regard to the ideal surgical strategy for correcting these rigid curves. Rigid scoliosis often presents in the form of either sharp angular or rounded deformities. Rounded deformities can be effectively managed with an anterior release to loosen the apex and posterior instrumentation (with osteotomies, if required). In contrast, severe rigid scoliosis, which is a sharp angular deformity, is not very amenable to anterior release and is best managed by posterior-only vertebral column resection and posterior instrumentation.
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Chen Z, Rong L. Comparison of combined anterior-posterior approach versus posterior-only approach in treating adolescent idiopathic scoliosis: a meta-analysis. 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; 25:363-71. [PMID: 25900299 DOI: 10.1007/s00586-015-3968-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Choosing a surgical approach to treat adolescent idiopathic scoliosis (AIS) is still controversial. To compare the effectiveness and safety of combined anterior-posterior approach to posterior-only approach, we conducted a meta-analysis. METHODS We searched electronic database for relevant studies that compared anterior-posterior approach with posterior approach in AIS. Then data extraction and quality assessment were conducted. We used RevMan 5.1 for data analysis. A random effects model was used for heterogeneous data, while a fixed effect model was used for homogeneous data. RESULTS A total of ten non-randomized controlled studies involving 872 patients were included. There was no significant difference in Cobb angle (95 % CI -0.33 to 4.91, P = 0.09) and percent-predicted FEV1 (95 % CI -6.79 to 4.54, P = 0.70) between the two groups. In subgroup analysis, the kyphosis angle correction was significantly higher than posterior group in severe subgroup (95 % CI 0.72-6.50, P = 0.01), while no significant difference was found in no-restriction subgroup (95 % CI -2.75 to 5.42, P = 0.52). Patients in posterior group obtained a better percent-predicted FVC than those in anterior-posterior group (95 % CI -13.18 to -4.74, P < 0.0001). Significant less complication rate (95 % CI 2.75-17.49, P < 0.0001), blood loss (95 % CI 363.28-658.91, P < 0.00001), operative time (95 % CI 2.65-3.45, P < 0.00001) and length of hospital stay (95 % CI 1.98-22.94, P = 0.02) were found in posterior group. CONCLUSIONS Posterior-only approach can achieve similar coronal plane correction and percent-predicted FEV1 compared to combined anterior-posterior approach. The posterior approach even does better in sagittal correction in severe AIS patients. Significantly less complication rate, blood loss, operative time, length of hospital stay and better percent-predicted FVC are also achieved by posterior-only approach. Posterior-only approach seems to be effective and safe in treating AIS for experienced surgeons.
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Affiliation(s)
- Zihao Chen
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, China
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Guangzhou, 510630, China.
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Cheung KMC, Lam JWN, Samartzis D, Lu WW, Luk KDK. The use of a modified fulcrum for fulcrum bending radiographs: a technical note. J Orthop Surg (Hong Kong) 2014; 22:248-51. [PMID: 25163967 DOI: 10.1177/230949901402200229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe a modified fulcrum design to overcome limitations of a traditional fulcrum. The modified fulcrum is a triangular prism-shaped foam with rounded and padded edges. The 3 faces of the fulcrum represent 3 different heights (17.0 cm, 17.5 cm, and 21.0 cm). For fulcrum bending radiographs of the thoracic curve, the patient is placed on an X-ray table in a lateral decubitus position over the fulcrum. The apex of the appropriate height of the fulcrum is positioned under the rib corresponding to the apex of the curve, such that the ipsilateral shoulder is lifted off the X-ray table for maximum passive bending force to the curve. For fulcrum bending radiographs of the lumbar curve, the fulcrum is positioned directly under the apex of the curve such that the ipsilateral iliac crest is lifted off the X-ray table.
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Affiliation(s)
- Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Effect of anterior mobilization and shortening in the correction of rigid idiopathic thoracic scoliosis. Spine (Phila Pa 1976) 2013; 38:E1662-8. [PMID: 24335636 DOI: 10.1097/brs.0000000000000030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of patients with anterior release and posterior correction instrumentation in a 2-stage procedure for rigid thoracic scoliosis. OBJECTIVE To examine the effect of the anterior release and shortening alone as well as its role in the overall correction. SUMMARY OF BACKGROUND DATA With segmental transpedicular instrumentation the need for an additional anterior mobilization became rare. However, its effect on sagittal profile was not sufficiently acknowledged. METHODS Twenty-two patients with rigid thoracic scoliosis (Lenke 1A, n = 3; 2A, n = 6; 2B, n = 2; 2C, n = 1; 4B, n = 1; 4C, n = 9 patients) were operated in a 2-stage procedure with anterior release followed by posterior correction. The anterior release included convex resection of the rib heads and shortening of the anterior column by resection of the discs and the convex anterolateral endplates in a mean of 8 (4-11) segments.After 14 days (6-27), the posterior instrumentation and correction was done. RESULTS The preoperative thoracic scoliosis measured a mean of 80°, upper thoracic 42°, and lumbar 49°. The thoracic curve corrected in bending 20° (25%), upper thoracic 10° (24%), and lumbar 26° (53%). The mean thoracic kyphosis (T5-T12) was 11°, lumbar lordosis was -41°.After the anterior release and shortening, thoracic scoliosis improved to 50°, thoracic kyphosis increased to 32°.After the posterior surgery the following values were noted: thoracic scoliosis 10°, upper thoracic 9°, lumbar 8°, thoracic kyphosis 25°, and lumbar lordosis -41°. The results were maintained at follow-up. CONCLUSION Anterior shortening results in a spontaneous correction of the thoracic scoliosis and hypokyphosis. In this series, the Cobb angle reduced 38% from a mean of 80° to a mean of 50°. Thoracic kyphosis increased from 11° to 32°. This correction was achieved without any corrective force or instrumentation. The second-stage posterior correction is facilitated and nearly complete correction is achieved with a residual curve on average of 10° with a physiological sagittal profile. LEVEL OF EVIDENCE 4.
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