Coronal Decompensation Produced by Cotrel—Dubousset “Derotation” Maneuver for Idiopathic Right Thoracic Scoliosis

Bridwell, Keith H.; McAllister, John W.; Betz, Randall; Huss, Gail K.; Clancy, Michael; Schoenecker, Perry L.

doi:10.1097/00007632-199107000-00015

Cited by 145 publications

(78 citation statements)

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“…Although spontaneous lumbar curve correction occurs consistently following a selective thoracic spinal fusion, the degree of correction is somewhat unpredictable. Previous studies have shown that over correction of the thoracic curve is related to progression of the lumbar curve below a selective thoracic fusion [42,43] due to lack of compensatory lumbar curve correction [30,[44][45][46][47][48][49]. It has been hypothesized that the unfused lumbar compensatory curve cannot compensate for excessive correction of the main thoracic curve and this therefore results in coronal decompensation [8,50,51].…”

Section: The Amount Of Correction For Selective Thoracic Fusionmentioning

confidence: 99%

“…Poor outcomes are related with progression of the unfused lumbar curve below a selective fusion [42,43], overcorrection of the thoracic curve [30,44,45], poor choice of fusion levels [42,47,56,57], incorrect identification of curve patterns [30,58], lumbar curve magnitude or stiffness [30,52], and relative position and rotation of the apical vertebrae [30,59]. In a study following patient outcomes with a minimum 5 years follow-up after selective thoracic fusion, the overall revision rate to accommodate worsening deformity was 6% (2/32 patients) [60].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

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Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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Selective fusion of thoracic and thoracolumbar/ lumbar curves in adolescent idiopathic scoliosis is a concept critically debated in the literature. While some surgeons strongly believe that a more rigid and straighter spine provides predictably excellent outcomes, some surgeons recommend a mobile and less straight spine. This topic is a crucial part of surgical treatment of idiopathic scoliosis, particularly in young patients who will deal with the stress of the fusion mass at the proximal and distal junctions over many years. This study will review the literature on various aspects of selective fusion.

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Section: The Amount Of Correction For Selective Thoracic Fusionmentioning

confidence: 99%

Section: Postoperative Complicationsmentioning

confidence: 99%

Selective fusion for adolescent idiopathic scoliosis: a review of current operative strategy

Fischer

Kim

2011

Eur Spine J

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“…On an AP film, the stable vertebra is that which is most nearly bisected by the mid-sacral line [6,31].…”

Section: Stable Vertebramentioning

confidence: 99%

An algorithm for selection of instrumentation levels in scoliosis

Margulies¹,

Floman

Robin

et al. 1998

European Spine Journal

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IntroductionAppropriate levels for instrumentation and fusion in idiopathic scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity some 80 years ago [7, 18, 23-25, 39, 45]. It is important to fuse the smallest possible number of vertebrae to maintain maximum residual mobility, but end with a well-balanced spine [36,54]. The longer the instrumentation, the greater the chance to gain control over the various curves and end up with a balanced spine. Shorter instrumentations may yield a well-balanced, mobile spine, with reduction of the scoliotic curves both in the instrumented and non-instrumented portions of the spine. Levels for fusion with Harrington instrumentation were defined according to King's classification [31, 32]. This approach does not emphasize the sagittal profile of the spine. Loss of lumbar lordosis with sagittal imbalance was quite common and known as the "flat back" syndrome [1,8,17, 34,35,52]. Subsequently, the sagittal profile was recognized to be important by Winter, Dickson and Armstrong [2,[11][12][13][56][57][58].With increased use of CD instrumentation and similar segmental systems, postoperative frontal imbalance has been more frequently noted than that reported with Harrington instrumentation. The newer posterior segmental systems facilitate better operative correction of scoliosis than Harrington instrumentation, and the option of anterior release enables even greater correction to be achieved.Abstract Appropriate levels for instrumentation and fusion in scoliosis have been a matter of debate among surgeons since the introduction of operative management of this deformity. We set out to examine the hypothesis that the amount of correction achieved in all planes during surgical instrumentation of a curve should be less than, or comparable to, the degree of correction attainable at any non-instrumented adjacent curve. An algorithm was designed to facilitate preoperative planning and intraoperative performance of spinal fusion procedures in the management of scoliosis. To test the validity of the hypothesis and the proposed algorithm, measurements were taken from the preoperative radiographs of 200 patients. The dimensions of the curves were obtained from an initial set of four X-ray films: (1) standing anteroposterior film of the whole spine, (2) standing lateral film of the whole spine, (3) two properly performed side-bending films including each curve of the spine. With this data, a plan was designed using the algorithm. The results of this plan were compared with the actual results of the surgery, which were revealed only at this stage. All patients in whom actual instrumentation levels fell within those predicted by the proposed algorithm had no imbalance at follow-up. All patients whose actual instrumentation levels were short of those recommended by the algorithm showed obvious imbalance on final postoperative standing radiograph.

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“…Although the standard treatment is posterior instrumentation for King type II curve, we advocate anterior correction, fusion and instrumentation of the thoracic curve in cases with significant thoracic hypokyphosis and in cases that a distal motion segment can be saved. However, as for posterior surgery the secondary lumbar curve should be flexible and correction of the thoracic curve should not exceed the amount of lumbar curve correction at preoperative bending X-rays [3,10,12,14]. None of our patients developed postoperative decompensation of the secondary lumbar curve.…”

Section: Discussionmentioning

confidence: 81%

“…Third generation rigid anterior instrumentation-related implant failure, loss of correction and pseudoarthrosis rates vary between 0% [3,5] and 5% [10,16] in the literature. To our knowledge, there is no study comparing single and Kaneda's double-rod constructs for anterior 319 Fig.…”

Section: Discussionmentioning

confidence: 99%