Clinical and Radiological Outcomes of Less Invasive Temporary Internal Distraction Followed by Staged Pedicle Screw Instrumentation in Adolescents with Severe Idiopathic Scoliosis at 2-Year Minimum Follow-Up

Abstract

Study Design. A single-center, retrospective study with a minimum 2-year follow up.Objectives. To describe and report the outcomes of minimal invasive temporary internal distraction (MI-TID) in the surgical treatment of adolescents with severe idiopathic scoliosis (SS).Summary of Background Data. Temporary internal distraction rod is one of the surgical options in severe scoliosis to avoid preoperative halo traction or vertebral column resection. This technique can be applied in a single session or staged and also using magnetically controlled growing rods to facilitate curve correction. Here we report the outcomes of simplistic initial minimal invasive internal distraction surgery followed by definitive segmental pedicle screw instrumentation with posterior column osteotomies.Methods. Twenty-two consecutive adolescents (19 girls, mean [SD] age 14.8 [2.0] years) with severe idiopathic scoliosis (major curve ≥ 90), who were treated using the MI-TID followed by staged pedicle screw instrumentation with minimum two-year follow-up. Demographic data, radiographic outcomes, pulmonary function tests (PFTs), perioperative data, Scoliosis Research Society 22 outcome questionnaire, complications, and neuromonitoring (NM) data were collected.Results. The major curve averaged preoperatively 120 (SD, 31°) and 58° (range 28°-65°) at final follow-up (p<0.001). Similarly, thoracic kyphosis (T5-T12) improved from 80 (42°) to 32° (range, 23°-68°) (p<0.001), and spinal height (T1-S1) increased from 332 mm (range, 198-432 mm) to 405 mm (range, 258-495 mm) (p<0.001). Five (23%) children had an intraoperative neuromonitoring change without postoperative neurologic deficits and two children developed superior mesenteric artery syndrome treated conservatively. Mean per cent predicted forced vital capacity (FVC) improved from 44.5% (11.3%) to 66.5 (10.8) at final follow-up(p<0.05).The SRS-22R total score improved significantly from 2.9 (0.61) to 4.1 (0.44) (p<0.05). Conclusion.Staged minimally invasive internal distraction followed by pedicle screw instrumentation is safe and effective in adolescents with severe idiopathic scoliosis improving spinal deformity, pulmonary function, and health-related quality.

Radiological and Pulmonary Results of Surgical Treatment of Severe Idiopathic Scoliosis Using Preoperative Halo Gravity Traction Compared with Less Invasive Temporary Internal Distraction in Staged Surgery in Adolescents

“…As an alternative to external traction techniques that use Halo traction, we can use internal traction-the TID method-in various configurations [16,19,20,24,[40][41][42]. We found that one study compared the outcomes of a Halo gravity traction course with temporary internal distraction [26].…”

“…The surgical intervention for patients in the G2 cohort was bifurcated into two stages. A refined version of the internal distraction techniques elucidated by Buchowski et al [16] and Skaggs et al [17], extensively expounded upon by Grabala and Helenius [24], was implemented during the surgical intervention. In essence, during the initial procedure, akin to minimally invasive surgical strategies for the standard deployment of growing rods across the proximal thoracic and lower lumbar spinal levels, segmental screws were situated, accompanied by posterior column osteotomies, typically within the exposed upper and lower spinal regions.…”

“…The preferred treatment approach for severe and rigid spinal curvatures is the utilization of preoperative Halo gravity traction (HGT) [9][10][11][12][13][14][15]. However, various alternative methods have also been introduced for managing severe spinal deformities, such as temporary internal distraction (TID) and its various adaptations, anterior release (AR), posterior release (PR), and thoracoplasty with rib osteotomy (TP), as well as different forms of three-column osteotomies like pedicle subtraction osteotomy (PSO) and vertebrectomy (commonly known as vertebral column resection (VCR)) [16][17][18][19][20][21][22][23][24][25]. Techniques involving gradual traction, whether external or internal, are typically viewed as safer compared with the more aggressive three-column osteotomy (3CO) approach, with a confined and acceptable incidence of complications [3,4,6,[10][11][12][15][16][17]20,24,26].…”

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

“…[ 9 10 ] Some authors have also used preoperative traction or internal distraction as a part of a staged correction, in order to achieve better correction and shorter fusion. [ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications.…”

“…[ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications. [ 18 19 20 ] Then, the introduction of all pedicle screws constructs allowed the all-posterior procedures to gradually gain popularity due to the high reliability of three-columnar fixation systems.…”