Operative Treatment of Adolescent Idiopathic Scoliosis With Posterior Pedicle Screw-Only Constructs

Lehman, Ronald A.; Lenke, Lawrence G.; Keeler, Kathryn A.; Kim, Yongjung J.; Buchowski, Jacob M.; Cheh, Gene; Kuhns, Craig A.; Bridwell, Keith H.

doi:10.1097/brs.0b013e318178872a

Cited by 188 publications

(102 citation statements)

References 42 publications

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“…Hybrid constructs with sub-laminar bands may not offer the same amount of coronal correction than all-screw constructs, however, this difference will not lead to inferior sagittal reciprocal changes. This consideration supports other reports questioning the necessity to obtain a perfect coronal correction to the detriment of sagittal alignment [10,19].…”

Section: Reciprocal Sagittal Interactions and Correlationssupporting

confidence: 90%

“…When applied, the rod-derotation maneuvers can lead to an improvement of the thoracic kyphosis with an average gain reported to be 5°by Suk et al [8], but this can also lead to coronal hypercorrection of the deformity with trunk inclination and shoulder asymmetry [18,19]. Results from this study confirm the ability of hybrid constructs using sub-laminar bands and clamps to maintain TK for normokyphotic patients, and to restore a satisfactory TK for hypokyphotic patients, by applying a posterior traction force on the spine toward pre-bent rods, with an average gain of 6.5°at last follow-up.…”

Section: Hybrid Constructs and Kyphosis Correctionmentioning

confidence: 99%

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Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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Purpose Surgical adolescent idiopathic scoliosis (AIS) management can be associated with loss of thoracic kyphosis and a secondary loss of lumbar lordosis leading to iatrogenic flatback. Such conditions are associated with poorer clinical outcomes during adulthood. The aim of this study was to evaluate sagittal plane reciprocal changes after posterior spinal fusion in the setting of AIS. Methods Thirty consecutive adolescents (mean age 14.6 years) with AIS Lenke 1, 2 or 3 were included in this retrospective study with 2 year follow-up. Full-spine standing coronal and lateral radiographs were obtained preoperatively, at 3 and 24 months postoperatively. Coronal Cobb angle, thoracic kyphosis (TK) and lumbar lordosis (LL) were measured. Surgical procedure was similar in all the cases, with use of pedicular screws between T11 and the lowest instrumented vertebra (CL2), sublaminar hooks applied in compression at the upper thoracic level and sub-laminar bands and clamps in the concavity of the deformity. Statistical analysis was done using t test and Pearson correlation coefficient. Results Between preoperative and last follow-up evaluations a significant reduction of Cobb angle was observed (53.6°vs. 17.2°, p \ 0.001). A significant improvement of the instrumented thoracic kyphosis, TK (19.7°vs. 26.2°, p \ 0.005) was noted, without difference between 3 and 24 months postoperatively. An improvement in lumbar lordosis, LL (43.9°vs. 47.3°, p = 0.009) was also noted but occurred after the third postoperative month. A significant correlation was found between TK correction and improvement of LL (R = 0.382, p = 0.037), without correlation between these reciprocal changes and the amount of coronal correction. Conclusion Results from this study reveal that sagittal reciprocal changes occur after posterior fusion when TK is restored. These changes are visible after 3 months postoperatively, corresponding to a progressive adaptation of patient posture to the surgically induced alignment. These changes are not correlated with coronal plane correction of the deformity. In the setting of AIS, TK restoration is a critical goal and permits favorable postural adaptation. Further studies will include pelvic parameters and clinical scores in order to evaluate the impact of the noted reciprocal changes.

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Section: Reciprocal Sagittal Interactions and Correlationssupporting

confidence: 90%

Section: Hybrid Constructs and Kyphosis Correctionmentioning

confidence: 99%

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

et al. 2012

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“…There was also a statistically significant correlation in four of the six coronal balance parameters measured. A recent study of 114 patients with AIS demonstrated maintenance of main curve correction and TL/LC correction from the immediate postoperative films to the 3-year followup radiographs [13]. Therefore, if the intraoperative film strongly correlates with the immediate postoperative film, which it did in our study, the surgeon can get an appreciation of the ultimate correction of the deformity.…”

Section: Discussionsupporting

confidence: 61%

“…Pedicle screws offer three-column fixation and reportedly provide curve correction, maintenance of correction, lower pseudarthrosis rates, fewer implant failures, and fewer postoperative bracing requirements than conventional hook and wire constructs [7,9,16,22]. Additionally, the safety of pedicle screws has been well documented with several large series of patients with AIS undergoing correction with minimal neurologic or visceral complications [13,23,24]. Kim et al [5] reported no neurologic or vascular complications with the placement of over 3000 thoracic pedicle screws.…”

Section: Introductionmentioning

confidence: 99%

Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

Lehman

Lenke

Helgeson³

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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It is often difficult to predict postoperative radiographic curve magnitude and balance parameters while performing intraoperative correction during scoliosis surgery. We asked whether there was a radiographic correlation between intraoperative long-cassette scoliosis film and postoperative standing radiographs of adolescent idiopathic scoliosis with pedicle screw instrumentation. We retrospectively reviewed 44 patients with adolescent idiopathic scoliosis who underwent posterior instrumentation with pedicle screws. We made preoperative, intraoperative (after instrumentation and correction), and standing postoperative radiographic measurements (eg, curve magnitudes, coronal and sagittal balance, disc angles) and compared those for the intra-and postoperative radiographs. The intraoperative long-cassette scoliosis film correlated with the immediate postoperative standing film for all curve correction and balance parameters. The routine use of a long-cassette intraoperative scoliosis film provides the surgeon with a valuable tool to guide intraoperative decision-making and foreshadows the correction and balance obtained on the immediate postoperative film.

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“…Thoracic pedicle screws instrumentation, without a direct vertebral derotation, has been found to enhance a loss of sagittal profile (from 8.4°to 12°) by several studies investigating the treatment of AIS [13,23,27,28,32]. In the study of Fu et al [14], at 2-years follow-up, thoracic kyphosis resulted less of the preoperative value (14.5 ± 6.5 vs. 15.8 ± 10.7) in patients treated with screws, in contrast with increased kyphosis obtained at follow-up with hooks construct.…”

Section: Discussionmentioning

confidence: 99%

Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality?

et al. 2012

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Introduction Direct apical vertebral rotation represents an important goal of posterior surgery for thoracic adolescent idiopathic scoliosis (AIS), so as to obtain a better cosmetic effect and to avoid posterior thoracoplasty. However, the real effectiveness in correction of vertebral rotation, using posterior only procedures, is still open to debate. The aim of the present study is to compare the correction of axial apical rotation obtained with direct rotation procedure versus simple concave rod rotation, in patients treated by posterior fusion for thoracic AIS using pedicle screw-only construct. Materials and methods A retrospective review was performed on a total of 62 consecutive patients (one single institution, three different surgeons) affected by AIS, who had undergone a posterior spinal fusion with pedicle screwonly instrumentation between January 2005 and April 2008 at the reference center. All cases presented a main thoracic curve (Lenke type 1 and 2). The angle of rotation (RAsag) of the apical vertebra was measured from the preoperative and last follow-up axial CT. According to the derotation procedure, two groups were identified: a direct vertebral rotation group (DR group; n = 32 patients) and a simple concave rod rotation group (No-DR group; n = 30 patients). There were no statistical differences between the two groups, in terms of age, Risser's sign, curve patterns, Cobb main thoracic (MT) curve magnitude and flexibility, extension of fusion, offset measurements on the coronal plane and sagittal preoperative contour. ResultsAll 62 patients were reviewed at an average follow-up of 3.7 years (range 2.5-4.2 years). The DR group compared to the No-DR group showed a significantly better final correction of apical vertebral rotation (DR 63.4 % vs. No-DR 14.8 %; p \ 0.05) and a greater final correction (61.3 vs. 52.4 %; p \ 0.05) with better maintenance of the initial correction (-1.7°vs. -1.9°; ns) of the main thoracic curve. Concerning the coronal balance, there was the same aforementioned trend of better results in the DR group, with less final apical MT vertebra translation (DR 2.2 cm vs. No-DR 4.1 cm), greater overall change (preop-final) of lower instrumented vertebra (LIV) coronal tilt (-14.9°vs. -11.1°; p \ 0.05); the final global coronal balance (C7-S1) resulted quite better in DR group, but without a significant difference. The T5-T12 kyphosis angle was quite similar in both group before surgery (DR 16.8°vs. No-DR 17.5°) and was little lower at final followup evaluation in direct vertebral rotation group (14.5°vs. 16.5°). The T10-L2 sagittal alignment angle was similar in each group before surgery , and at the latest follow-up averaged 5.3°versus 8.2°, respectively. Lumbar lordosis was similar in each group before surgery (DR -42°vs. No-DR -44.1°) and at the final follow-up evaluation (-45.9°vs. -43.2°). At the latest follow-up, SRS-30 and SF-36 findings were similar between the two groups. The complication rate was higher in the simple concave rod rotation group (13.3 vs. 9.3 %), r...

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Operative Treatment of Adolescent Idiopathic Scoliosis With Posterior Pedicle Screw-Only Constructs

Cited by 188 publications

References 42 publications

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis

Do Intraoperative Radiographs in Scoliosis Surgery Reflect Radiographic Result?

Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis: myth or reality?

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