Comparison of 1-Stage Versus 2-Stage Anterior and Posterior Spinal Fusion for Severe and Rigid Idiopathic Scoliosis–A Randomized Prospective Study

Shen, Jianxiong; Qiu, Guixing; Wang, Yipeng; Zhang, Zhihai; Zhao, Yu

doi:10.1097/01.brs.0000240704.42264.c4

Cited by 53 publications

(43 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Scoliosis with a high angular value can be treated by anterior approach alone according to Shen et al, 11 who described their study in which they performed anterior release associated with instrumentation and fusion in 12 patients with an average Cobb of 98.5°, obtaining 59.5% correction. Anterior release via thoracoscopy prior to posterior arthrodesis has been described as being less invasive and optimizing clinical results, but the technical difficulty of this procedure in patients with severe deformity of the thoracic cage is a limiting factor.…”

Section: Discussionmentioning

confidence: 99%

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

et al. 2017

View full text Add to dashboard Cite

Objective: To report a new technique for extrapleural interbody release with transcorporal osteotomy of the inferior vertebral plateau (LIEPO) and to evaluate the correction potential of this technique and its complications. Method: We included patients with scoliosis with Cobb angle greater than 90° and flexibility less than 25% submitted to surgical treatment between 2012 and 2016 by the technique LIEPO at the National Institute of Traumatology and Orthopedics (INTO). Sagittal and coronal alignment, and the translation of the apical vertebra were measured and the degree of correction of the deformity was calculated through the pre and postoperative radiographs, and the complications were described. Results: Patients had an average bleed of 1,525 ml, 8.8 hours of surgical time, 123° of scoliosis in the preoperative period, and a mean correction of 66%. There was no case of permanent neurological damage and no surgical revision. Conclusion: The LIEPO technique proved to be effective and safe in the treatment of severe stiff scoliosis, reaching a correction potential close to the PEISR (Posterior extrapleural intervertebral space release) technique and superior to that of the pVCR (posterior Vertebral Column Resection) with no presence of infection and permanent neurological deficit. New studies are needed to validate this promising technique.Keywords: Scoliosis/surgery; Spine/surgery; Osteotomy; Treatment outcome. RESUMO

show abstract

Section: Discussionmentioning

confidence: 99%

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The combined anterior and posterior procedure was performed in one-or two-stage surgery by different authors with different outcomes. Shufflebarger et al [2] found that a reduction in hospital stay and operating time led to fewer complications, and better correction in the continuous group compared with the staged one; more recently, Shen et al [3] concluded that there was no significant difference in the safety or efficacy between the one-or two-stage groups. Additional anterior surgery requires increased time for the general anesthesia and may have a negative impact on pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation

et al. 2013

View full text Add to dashboard Cite

Purpose Posterior-only approach arthrodesis by all-pedicle screw instrumentation has a correction rate similar to correction obtained by traditional combined anterior/posterior approach surgery and avoids the complications associated with the thoracic approach. Methods We treated 25 patients, with a mean age 16.5 years, with severe adolescent idiopathic scoliosis by posterior-only approach using all-screw instrumentation arthrodesis. Mean scoliosis curve in Cobb degrees was 95°C obb. All cases were treated by the same senior surgeon, by free hand technique, without intraoperative neurophysiologic monitoring and spine navigation aids. Results Mean scoliosis curve after surgery was 37°Cobb. Mean follow-up was 4 years. No perioperative complications, curve progression or arthrodesis malunion were reported at the follow-up. Conclusions Posterior spinal fusion with pedicle screwonly instrumentation obtains a good and stable correction of severe scoliosis; compared to hybrid instrumentation, it allows a greater coronal correction of the deformity and less correction loss at the follow-up.

show abstract

“…The combined anterior and posterior procedure was performed in 1-or 2-stage surgery according to different authors with different outcomes. Shufflebarger et al [46] found decreased hospital stay and operating time, fewer complications, and better correction in the continuous group compared to the staged group; more recently Shen et al [45] concluded that there was no significant difference in safety or efficacy between the 1-or 2-stage groups.…”

Section: Introductionmentioning

confidence: 99%

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

et al. 2008

View full text Add to dashboard Cite

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80°traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5-8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic ([80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80°(Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF-H group; n = 27 patients), or with pedicle screw-only construct (PSF-S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser's sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF-H: 92°vs. PSF-S: 88°), or flexibility on bending films (PSF-H: 27% vs. PSF-S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for nonparametric paired analysis, and the Mann-Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF-S group, when compared to the PSF-H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of -1.9°versus -11.3°( P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (-1.00 vs. -0.54 cm; P = 0.04), and tilt (-19°vs. -10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF-H = 0.5 cm vs. PSF-S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and...

show abstract

Comparison of 1-Stage Versus 2-Stage Anterior and Posterior Spinal Fusion for Severe and Rigid Idiopathic Scoliosis–A Randomized Prospective Study

Abstract: A comparison of 1-stage versus 2-stage fusion in treating rigid thoracic curves in AIS did not show significant differences in safety or efficacy but did demonstrate significant difference in length of stay and patient cost.

Cited by 53 publications

References 6 publications

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

Correction of Severe Stiff Scoliosis Through Extrapleural Interbody Release and Osteotomy (Liepo)

Treatment of severe scoliosis with posterior-only approach arthrodesis and all-pedicle screw instrumentation

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

Contact Info

Product

Resources

About