Choice of Rods in Surgical Treatment of Adolescent Idiopathic Scoliosis: What Are the Clinical Implications of Biomechanical Properties? – A Review of the Literature

Ohrt-Nissen, Søren; Dahl, Benny; Gehrchen, Martin

doi:10.14245/ns.1836050.025

Cited by 40 publications

(36 citation statements)

References 64 publications

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“…Patients with fixed sagittal malalignment are unable to stand erect without flexing their hips or knees due to the loss of segmental lumbar lordosis (LL) 5,26,27) . Disruption of normal sagittal alignment results in significant pain and disability, and associated with low health-related quality of life 13) .…”

Section: Introductionmentioning

confidence: 99%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to report the results of pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance with a minimum 2-year follow-up. Besides, authors evaluated the effect of adjunctive multi-level posterior column osteotomy (PCO) on achievement of additional lumbar lordosis (LL) during PSO. Methods : A total of 31 consecutive patients undergoing PSO for fixed sagittal imbalance were enrolled and analyzed. Correction angle of osteotomized vertebra (PSO angle) and other radiographic parameters including pelvic incidence (PI), thoracic kyphosis, LL, and sagittal vertical axis (SVA) were evaluated. Clinical outcomes and surgical complications were also assessed. Results : The mean age was 66.0±9.3 years with a mean follow-up period of 33.2±10.5 months. The mean number of fused segments was 9.6±3.5. The mean operative time and surgical bleeding were 475.9±160.5 minutes and 1406.1±932.1 mL, respectively. The preoperative SRS-22 score was 2.3±0.7 and improved to 3.2±0.8 at the final follow-up. The mean PI was 54.5±9.5°. LL was changed from 7.0±28.9° to-50.2±13.2°. The PSO angle was 33.7±13.5° (15.6±20.1° preoperatively,-16.1±19.4° postoperatively). The difference of correction angle of LL (57.3°) was greater about 23.6° than which of PSO angle (33.7°). SVA was improved from 189.5±93.0 mm, preoperatively to 12.4±40.8 mm, postoperatively. There occurred six, eight, and 14 cases of complications at intraoperative, early (<2 weeks) postoperative, and late (≥2 weeks) postoperative period, respectively. Additional operations were needed in nine patients due to the complications. Conclusion : PSO could provide satisfactory results for patients with fixed sagittal imbalance regarding clinical and radiographic outcomes. Additional correction of LL could be achieved with conduction of adjunctive multi-level PCOs during PSO.

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Section: Introductionmentioning

confidence: 99%

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Choi

Hyun

Kim

et al. 2020

J Korean Neurosurg Soc

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“…It is known to be important that biomechanical properties are dependent on the material of rod. CoCr rod has in recent years been introduced for major spinal deformity surgery, which is characterized by a very high mechanical stiffness 7,20) .…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

Park

Hyun

Wui

et al. 2020

J Korean Neurosurg Soc

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The purpose of this study was to evaluate surgical outcomes and complications of spinal deformity associated with neurofibromatosis type-1 (NF-1). Methods : From 2012 to 2018, patients suffering from spinal deformity associated with NF-1 who underwent surgical correction were identified. Demographic data and radiographic measures were retrospectively reviewed. Pre-and postoperative whole spine radiograph images were used to determine both coronal and sagittal Cobb angles. All of patients underwent 3-dimentional computed tomographic scan and magnetic resonance imaging scan to confirm dystrophic features. For evaluation of clinical outcomes, we surveyed the pre-and postoperative scoliosis research society-22r (SRS-22r) score. Results : Seven patients with spinal deformity associated with NF-1 were enrolled in this study. The mean age of patients was 29.5±1.2 years old. The mean follow-up period was 2.8±1.4 years. The apex of the deformity was located in cervicothoracic (n=1), thoracic (n=4), and lumbar region (n=2). Most patients have poor bone quality and decreased bone mineral density with average T-score of-3.5±1.0. All patients underwent surgical correction via posterior approach. The pre-and postoperative mean coronal and sagittal Cobb angle was 61.6±22.6° and 34.6±38.1°, 56.8±18.5° and 40.2±9.1°, respectively. Mean correction rate of coronal and sagittal angle was 44.7% and 23.1%. Ultimate follow-up SRS-22r score (average score, 3.9±0.4) improved comparing to preoperative score (average score, 3.3±0.9). Only one patient received revision surgery due to rod fracture. No serious complication occurred, such as neurological deficit, and viscerovascular injury. Conclusion : The surgical correction of patients having spinal deformity associated with NF-1 is challenging, however the radiographic and clinical outcomes are satisfactory. The all posterior approach can be a safe and effective surgical option for patients having dystrophic curves associated with NF-1.

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“…However, most existing studies have mainly focused on the natural history of thoracolumbar curvature, and few studies have investigated cervical curvature. [8][9][10] In addition, as NMDs themselves are rare, there is a tendency for reports to focus on cerebral palsy, which is a relatively common NMD. 11 Generally, it has been reported that deformity curve progression is more common in patients with NMDs than in adolescent idiopathic scoliosis (AIS) patients with similar patterns.…”

Section: Natural History and Risk Factors For Spinal Deformity Progrementioning

confidence: 99%

“…By understanding the natural history of spinal deformities, we might be able to predict the probability and pattern of curve progression, and on that basis develop a treatment plan (e.g., the decision between surgical or conservative treatment), obtain informed consent from patients, and educate patients appropriately. However, most existing studies have mainly focused on the natural history of thoracolumbar curvature, and few studies have investigated cervical curvature [ 8 - 10 ]. In addition, as NMDs themselves are rare, there is a tendency for reports to focus on cerebral palsy, which is a relatively common NMD [ 11 ].…”

Section: Natural History and Risk Factors For Spinal Deformity Progrementioning

confidence: 99%

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders

Lee

Jeong

et al. 2020

Neurospine

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Neuromuscular disorders (NMDs) are diseases involving the upper and lower motor neurons and muscles. In patients with NMDs, cervical spinal deformities are a very common issue; however, unlike thoracolumbar spinal deformities, few studies have investigated these disorders. The patients with NMDs have irregular spinal curvature caused by poor balance and poor coordination of their head, neck, and trunk. Particularly, cervical deformity occurs at younger age, and is known to show more rigid and severe curvature at high cervical levels. Muscular physiologic dynamic characteristics such as spasticity or dystonia combined with static structural factors such as curvature flexibility can result in deformity and often lead to traumatic spinal cord injury. In addition, postoperative complication rate is higher due to abnormal involuntary movement and muscle tone. Therefore, it is important to control abnormal involuntary movement perioperatively along with strong instrumentation for correction of deformity. Various methods such as botulinum toxin injection, physical therapy, muscle division technique, or intrathecal baclofen pump implant may help control abnormal involuntary movements and improve spinal stability. Surgical management for cervical deformities associated with NMDs requires a multidisciplinary effort and a customized strategy.

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Choice of Rods in Surgical Treatment of Adolescent Idiopathic Scoliosis: What Are the Clinical Implications of Biomechanical Properties? – A Review of the Literature

Cited by 40 publications

References 64 publications

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Radiographic and Clinical Outcomes Following Pedicle Subtraction Osteotomy : Minimum 2-Year Follow-Up Data

Surgical Outcomes and Complications Following All Posterior Approach for Spinal Deformity Associated with Neurofibromatosis Type-1

Surgical Strategies for Cervical Deformities Associated With Neuromuscular Disorders

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