Correction of Main Thoracic Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation

Quan, Gerald M. Y.; Gibson, Michael J.

doi:10.1097/brs.0b013e3181b4af34

Cited by 117 publications

(83 citation statements)

References 21 publications

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“…This improvement in thoracic kyphosis confirms previous results on the use of the UC for both AIS and neurologic scoliosis [13,16,20], and contrasts with a large body of evidence suggesting that conventional all-pedicle screw constructs tend to worsen flatness of the thoracic spine in AIS [3,4,7,8,[28][29][30][31][32][33] unless rod derotation is the predominant means used to correct coronal deformity (see Table 1) [6,[34][35][36][37]. Based upon a retrospective study of patients with Lenke type 1 AIS treated with all-pedicle screw instrumentation, Quan and Gibson recently concluded that the greater the coronal plane correction achieved with pedicle-screw constructs, the greater the loss of thoracic kyphosis [33]. The authors of a large multicenter analysis of patients with Lenke type 1 AIS surgically treated by a selective thoracic fusion have recommended techniques that lengthen the posterior column in order to maintain or increase thoracic kyphosis [31].…”

Section: Discussionsupporting

confidence: 83%

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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Purpose Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs. The Universial Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that applies traction to the sublaminar band permits gentle translation of the thoracic curve to the precontoured fusion rods, which have been previously anchored distally by pedicle screws and proximally by hooks in a claw configuration. The aim of this study was to evaluate radiographic results of AIS treatment using UC hybrid constructs.Methods This was a prospective case series in which 29 consecutive patients with Lenke type 1, 2 or 3 AIS operated on by two surgeons in two centers were followed for 24 months. Necessity for anterior release was an exclusion criterion. Results A total of 5.4 ± 1.4 UCs were used per patient. The major thoracic curve was reduced from 55 ± 7°to 14 ± 6°at 1 month and 17 ± 6°at 24 months (correction 70%) without complications. In the patients who had less than 20°of T5-T12 kyphosis preoperatively, thoracic kyphosis improved from 14 ± 4°to 20 ± 3°at 3 months and 24 ± 9°at 24 months. In the other patients, preoperative thoracic kyphosis (27°± 6°) was unchanged by the operation. Conclusion UC hybrid constructs appear to safely provide satisfying coronal correction while consistently improving thoracic kyphosis in patients who also have preoperative hypokyphosis. We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands.

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Section: Discussionsupporting

confidence: 83%

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Gauzy

Jouve

Accadbled

et al. 2011

Journal of Children's Orthopaedics

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“…A recent prospective cohort study with 10-year follow-up conducted by Min et al [44] has shown good correction with a pedicle screw implant density of 50 %. High implant density has not shown improvement in patient reported outcomes [38][39][40][41][42][43][44] or cosmesis [39], and has contributed to less thoracic kyphosis [38,40,41], and high costs [42,45]. In contrast to what might be expected, it was shown through a finite element analysis and computational study that high implant density does not improve the distribution of forces and correction [46,47].…”

Section: Supporting Empirical Evidencementioning

confidence: 95%

“…Some studies have shown slightly larger radiographic correction with high implant density [38][39][40], while others have shown no correlation between implant density and curve correction [41][42][43]. A recent prospective cohort study with 10-year follow-up conducted by Min et al [44] has shown good correction with a pedicle screw implant density of 50 %.…”

Section: Supporting Empirical Evidencementioning

confidence: 99%

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

et al. 2014

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Purpose The surgical management of adolescent idiopathic scoliosis (AIS) has seen many developments in the last two decades. Little high-level evidence is available to support these changes and guide treatment. This study aimed to identify optimal operative care for adolescents with AIS curves between 40°and 90°Cobb angle. Methods From July 2012 to April 2013, the AOSpine Knowledge Forum Deformity performed a modified Delphi survey where current expert opinion from 48 experienced deformity surgeons, representing 29 diverse countries, was gathered. Four rounds were performed: three web-based surveys and a final face-to-face meeting. Consensus was achieved with C70 % agreement. Data were analyzed qualitatively and quantitatively.Results Consensus of what constitutes optimal care was reached on greater than 60 aspects including: preoperative radiographs; posterior as opposed to anterior (endoscopic) surgical approaches; use of intraoperative spinal cord monitoring; use of local autologous bone (not iliac crest) for grafts; use of thoracic and lumbar pedicle screws; use of titanium anchor points; implant density of \80 % for 40°-70°curves; and aspects of postoperative care. Variability in practice patterns was found where there was no consensus. In addition, there was consensus on what does not constitute optimal care, including: routine pre-and intraoperative traction; routine anterior release; use of bone morphogenetic proteins; and routine postoperative CT scanning. operative care for adolescents with AIS. In the absence of current high-level evidence, at present, these expert opinion findings will aid health care providers worldwide define appropriate care in their regions. Areas with no consensus provide excellent insight and priorities for future research.

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“…Quan et al [15] also documented a significant correlation between reduced sagittal kyphosis and the magnitude of coronal Cobb angle correction in 49 consecutive patients with Lenke 1 main thoracic AIS who underwent singlestage posterior correction and instrumented spinal fusion with pedicle screw fixation. In contrast, Clement et al [31] documented a mean gain of 14°of thoracic kyphosis with pedicle screw instrumentation in patients with severe preoperative hypokyphosis.…”

Section: Discussionmentioning

confidence: 92%

“…Several reports have demonstrated that pedicle screws are superior for correcting scoliosis, in terms of the mean absolute degrees and percentage of curve correction, in comparison with posterior hook-and-wire or hybrid constructs [9][10][11]. Among the several surgical techniques available, pedicle screw instrumentation is considered to be reliable and safe [12][13][14], but clinical trials have reported a lordogenic effect with this form of posterior instrumentation [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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Posterior pedicle screw fixation is now the standard treatment for surgical correction of idiopathic scoliosis and has largely replaced anterior techniques, but there have been reports describing a lordogenic effect of segmental pedicle screw instrumentation in the thoracic spine. This clinical study compared anterior dual rod instrumentation with posterior pedicle screw fixation for idiopathic thoracic lordoscoliosis, including 42 patients (7 male, 35 female; average age 16 years, range 12-34) who underwent posterior pedicle screw fixation (n = 20) or anterior dual rod instrumentation (n = 22) at two centers. The average follow-up period was 33 months (24-108 months). Inclusion criteria were a diagnosis of adolescent idiopathic scoliosis with a structural thoracic curve (Lenke 1-3) and thoracic hypokyphosis (T4-T12 \ 20°). The main thoracic curve magnitude and sagittal profile on standing radiographs were evaluated. Thoracic kyphosis was significantly restored from preoperatively 10.2°to 23.4°postoperatively in the anterior group and from 7.6°to 12.9°in the posterior group (P \ 0.005). Kyphosis improved significantly better in the anterior group than in the posterior group (P \ 0.005). The preoperative and postoperative main thoracic curve values were 63°(48-80°) and 25.2°in the anterior group and 60.6°(50-88°) and 23.6°in the posterior group, with no significant differences between the groups. No neurological or other severe complications were observed. Anterior dual rod instrumentation in patients with thoracic lordoscoliosis allows significantly better restoration of thoracic kyphosis than posterior pedicle screw instrumentation.

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Correction of Main Thoracic Adolescent Idiopathic Scoliosis Using Pedicle Screw Instrumentation

Abstract: Pedicle screw constructs provided excellent coronal correction of thoracic idiopathic scoliosis, however, this was at the expense of sagittal contour. Bilateral segmental pedicle screw fixation did not improve curve correction compared with unilateral or alternate segmental fixation.

Cited by 117 publications

References 21 publications

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Use of the Universal Clamp in adolescent idiopathic scoliosis for deformity correction and as an adjunct to fusion: 2-year follow-up

Optimal surgical care for adolescent idiopathic scoliosis: an international consensus

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

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