Long-term Outcomes of Anterior Spinal Fusion With Instrumentation for Thoracolumbar and Lumbar Curves in Adolescent Idiopathic Scoliosis

Kelly, Derek M.; McCarthy, R.; McCullough, Frances L; Kelly, Hallie R.

doi:10.1097/brs.0b013e3181bc948e

Cited by 63 publications

(39 citation statements)

References 20 publications

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“…Long-term outcomes have been reported using older posterior spinal instrumentation constructs [1,[21][22][23]28] as well as anterior spinal fusions [24,25]. Some series have reported slight increases or progression of radiographic parameters, but most have displayed evidence of correction maintenance with increased follow-up extending up to 20 years [1,[22][23][24][25]28].…”

Section: Discussionmentioning

confidence: 99%

“…Some series have reported slight increases or progression of radiographic parameters, but most have displayed evidence of correction maintenance with increased follow-up extending up to 20 years [1,[22][23][24][25]28]. Although several studies comparing earlier instrumentation systems have evaluated long-term surgical outcomes in AIS, the relatively recent innovation of thoracic pedicle screws has limited the longterm data available for pedicle screw-only constructs [1,2,21,22,26,27,29].…”

Section: Discussionmentioning

confidence: 99%

“…Although long-term results have been reported for older instrumentation types and anterior constructs, clinical and radiographic outcomes of pedicle screw only constructs are largely based on short to mid-term follow-up with a paucity of data addressing mid-to longer term results [1,[21][22][23][24][25]. Suk et al [26] reported a 3 % loss of radiographic correction at 5-year follow-up, but did not have clinical correlation.…”

Section: Introductionmentioning

confidence: 99%

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Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis

et al. 2012

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Purpose To determine the mid-term clinical and radiographic impact of pedicle screw fixation in patients with adolescent idiopathic scoliosis (AIS). Methods A multicenter AIS database was retrospectively queried to identify 99 consecutive patients who underwent posterior spinal fusion using an all pedicle screw construct with a minimum of 5-year follow-up. Radiographic and clinical parameters were reviewed at regular intervals up to 5 years. ResultsThe mean age was 14.4 ± 2.0 years with 79 % being female. The mean preoperative major curve was 51.7 ± 14.2°with a mean correction of 66 and 64 % at 2 and 5 years (p = 0.16). Pre-op thoracic kyphosis averaged 22.3 ± 12.9°and was 18.4 ± 10.6°at 5 years with no significant change from 2 years (p = 0.33). SRS total and domain scores demonstrated significant improvements at 2 years, which were slightly decreased at 5 years (p = 0.06). SRS scores of self-image (p = 0.99) and satisfaction (p = 0.18) were significantly improved after surgery with minimal change by 5 years. The change in SRS total scores from 2 to 5 years was attributed to differences in SRS scores of pain and mental health (p \ 0.05). Conclusions Intermediate follow-up of patients with AIS treated with an all pedicle screw construct demonstrates maintenance of their coronal, and sagittal plane correction between 2-and 5-year follow-up. At 5 years, improvements in SRS scores were consistent with 2-year values, except for a decline in pain and mental health scores.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis

et al. 2012

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“…1,3,4,11,14,24 However, long-term data on the pedicle screw construct are limited. 1,3,4,15,23 In 2005, Suk et al studied 203 patients with AIS who underwent segmental thoracic pedicle screw fixation; they reported a 69% correction of the main thoracic curve and a 66% correction of the compensatory lumbar curve and good maintenance of the sagittal profile at 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves

Bennett¹,

Hoashi²,

Ames³

et al. 2013

SPI

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T wo approaches (anterior and posterior) are used for the treatment of thoracolumbar and lumbar adolescent idiopathic scoliosis (AIS). 2,6,7,9,12,13,16,[20][21][22] In 1969, Dwyer et al. first proposed the anterior approach for the treatment of thoracolumbar and lumbar curves with use of vertebral body screws and a compression cable. This approach resulted in good coronal correction but also resulted in a kyphosing effect, poor derotation, and a high rate of pseudarthrosis. 6,7,12,16 Later, to improve derotation, Zielke replaced the wires with an anterior threaded rod, but the kyphosing effect and high rate of pseudarthrosis remained.2,13 Later, dual anterior solid rods were developed and resulted in better coronal correction, improved derotation, and less kyphosis. 21The first posterior approach to be accepted for treatment of thoracolumbar and lumbar AIS was the Harrington method, which used posterior hooks and rods. Shriners Hospitals for Children, Philadelphia, PennsylvaniaObject. Several studies of the outcomes of patients with adolescent idiopathic scoliosis (AIS) with thoracolumbar and lumbar curves after treatment with posterior pedicle screws have been reported, but most of these studies reported only 2-year follow-up. The authors analyzed the radiographic and clinical outcomes of patients with thoracolumbar and lumbar curves treated with posterior pedicle screws after 5 years of follow-up.Methods. A multicenter database was retrospectively queried to identify patients with AIS who underwent spinal fusion for Lenke 3C, 5C, and 6C curves. Radiographs from the following times were compared: preoperative, first follow-up visit, 1-year follow-up visit, 2-year follow-up visit, and 5-year follow-up visit. Chart review included scoliometer measurements, Scoliosis Research Society (SRS)-22 questionnaires, and complications requiring return to the operating room.Results. Among 26 patients with Lenke 3C, 5C, and 6C curves, the mean (± SD) age was 14.6 ± 2.1 years. From the time of the preoperative radiographs to the 5-year follow-up radiographs, there was a statistically significant improvement in the mean coronal lumbar Cobb angles (p < 0.0001), and from the time of the first postoperative radiographs to the 5-year follow-up radiographs, the lumbar curve remained stable (p = 0.14). From the time of the preoperative radiographs to the 5-year follow-up radiographs, there was a statistically significant improvement in the mean coronal thoracic Cobb angles (p < 0.0001), and from the time of the first postoperative radiographs to the 5-year follow-up radiographs, the thoracic curve remained stable (p = 0.10). From the first postoperative visit to the 5-year follow-up visit, the thoracic kyphosis (T5-12) remained stable (p = 0.10), and from the time of the preoperative radiographs to the 5-year follow-up radiographs, the lumbar lordosis (T-12 to top of sacrum) remained stable (p = 0.44). From the preoperative visit to the 5-year follow-up visit, the coronal balance improved significantly (p < 0.05) and remained stabl...

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“…In the present study, an average of 35 years after surgery, 68.6% of the patients had intervertebral disc degeneration of Pfirrmann grade 4 or higher. However, a previous study reported that MRI findings might not always be related to patient reported questionnaires 16) . Based on SRS-22, RDQ, and/or ODI, the findings did not relate to low back pain.…”

Section: Discussionmentioning

confidence: 99%

Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery

Akazawa

Kotani

Sakuma

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: The purpose of this study was to investigate the long-term incidence of lumbar disc degeneration and Modic changes in the non-fused segments of patients with adolescent idiopathic scoliosis (AIS) who previously underwent spinal fusion.Methods: Study subjects consisted of 252 patients with AIS who underwent spinal fusion between 1968 and 1988. Of 252 patients, 35 subjects underwent lumbar spine MRI and whole spine X-ray examination. The mean patient age at the time of follow-up was 49.8 years, with an average follow-up period of 35.1 years. We classified the subjects into two groups based on the lowest fused vertebra: H group whose lowest fused vertebra was L3 or higher levels and L group whose lowest fused vertebra was L4 or lower levels.Results: The L group had significantly advanced disc degeneration on MRI. There was no significant difference between two groups in Modic changes. The L group showed less lumbar lordosis than the H group (H group: 48.1 degrees; and L group: 32.1 degrees) and greater SVA (H group: 1.2 cm; and L group: 5.5 cm).Conclusions: In AIS patients, 35 years after spinal fusion surgery on average, we evaluated lumbar disc degeneration and Modic changes of the non-fused segments. In patients with the lowest fusion level at L4 or lower, there were reduced lumbar lordosis, considerable SVA imbalance, and severe disc degeneration compared with those with the lowest fusion level at L3 or higher. The lowest fusion level at L3 or higher is recommended to reduce disc degeneration in midlife.

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Long-term Outcomes of Anterior Spinal Fusion With Instrumentation for Thoracolumbar and Lumbar Curves in Adolescent Idiopathic Scoliosis

Abstract: The anterior approach in the treatment of thoracolumbar and lumbar curves in AIS offers good long-term functional outcomes for patients. Despite expected degenerative changes, patients scored well on the SRS and Oswestry tests, and were able to pursue careers and family activities.

Cited by 63 publications

References 20 publications

Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis

Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis

The posterior pedicle screw construct: 5-year results for thoracolumbar and lumbar curves

Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery

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