Anterior dual rod instrumentation in idiopathic thoracic scoliosis

Abstract

For anterior correction and instrumentation of thoracic curves single rod techniques are widely used. Disadvantages of this technique include screw pullouts, rod fractures and limited control of kyphosis. This is a prospective study of 23 consecutive patients with idiopathic thoracic scoliosis treated with a new anterior dual rod system. Aim of the study was to evaluate the safety and efficacy of this new technique in the surgical treatment of idiopathic thoracic scoliosis. To the best knowledge of the authors, this is the largest series on dual rod dual screw instrumentation over the entire fusion length in thoracic scoliosis. Twenty-three patients with an average age of 15 years were surgically treated with a new anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 28 months (24-46 months). Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 66.6 degrees to 28.3 degrees (57.5% correction) with an average loss of correction of 2.0 degrees at Cobb levels and of 1.3 degrees at fusion levels. Spontaneous correction of the secondary lumbar curve averaged 43.2% (preoperative Cobb angle 41.2 degrees ). The apical vertebral rotation was corrected by 41.1% with a consecutive correction of the rib hump of clinically 66.7%. The thoracic kyphosis measured 29.2 degrees preoperatively and 33.6 degrees at follow-up. In seven patients with a preoperative hyperkyphosis of on average 47.3 degrees thoracic kyphosis was corrected to 41.0 degrees . This new instrumentation enables an entire dual rod instrumentation over the whole thoracic fusion length. It offers primary stability without the need of postoperative bracing. Dual screw dual rod instrumentation offers the advantages of a high screw pullout resistance, an increased overall stability and satisfactory sagittal plane control.

Anterior short correction in thoracic adolescent idiopathic scoliosis with mini-open thoracotomy approach: prospective clinical, radiological and pulmonary function results

“…Most reports on the anterior thoracic instrumentation used end-to-end fusions, in which length of the fusion was the same as the curve length [2, 4-6, 9, 11, 14]. Liljenqvist et al [14] reported anterior fusion with dual rod instrumentation and end-to-end fusions, with a thoracic curve correction of 57.5%. Brodner et al [15] reported on short fusions using dual rod instrumentation in single thoracic curves but the prospective pulmonary function results were not available.…”

“…Pseudarthrosis and implant failures were also reported [11,12]. The length of standard thoracotomy exposure, the length of spinal fusion and the bulk of anterior implants may be contributing factors for the postoperative reduction of pulmonary function [13,14]. We used a mini-thoracotomy incision for exposure and low-profile implants for the instrumentation of the thoracic spine.…”

Sagittal balance of thoracic lordoscoliosis: anterior dual rod instrumentation versus posterior pedicle screw fixation

“…In a previous study [33], our group documented a kyphogenic trend when an anterior dual rod instrumentation system was used to treat thoracic scoliosis in 23 patients. The better restoration provided by anterior dual rod instrumentation is probably due to using a second solid rod, allowing individual contour adjustment.…”

Idiopathische Skoliose – Ätiologie, Klassifikation und Therapie

“…Die Vorteile insbesondere der ventralen Derotationsspondylodese nach Zielke sind die kurze Fusionsstrecke und die gute Derotation und Korrektur in der frontalen Ebene. Die Nachteile der fehlenden Primärstabilität sowie der mangelnden Kontrolle des sagittalen Profils konnten im Rahmen von Weiterentwicklungen eliminiert werden [9]. …”