Preoperative skull tongs-femoral traction versus cotrel longitudinal traction for rigid and severe scoliosis: Cohort study

Librianto, Didik; Saputra, Reza; Djaja, Yoshi Pratama; Phedy, Phedy; Fachrisal,; Saleh, Ifran

doi:10.1016/j.amsu.2021.02.023

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…The lack of understanding of the natural history and compensatory mechanism of CB/CIB inspired us to propose the apical vertebras distribution modifier to supplement the CB classification for AdIS with a severe curve, which is defined as Cobb angle > 80 degrees in this study [ 7 , 8 , 9 , 10 ] ( Figure 1 and Figure 2 ). A corresponding surgical algorithm is also proposed to address each type of coronal alignment.…”

Section: Introductionmentioning

confidence: 99%

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

Pan

Hai

Lenke

et al. 2023

JPM

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Background: We aimed to propose the apical vertebras distribution modifier to supplement the coronal balance (CB) classification for adult idiopathic scoliosis (AdIS). An algorithm to predict postoperative coronal compensation and avoid postoperative coronal imbalance (CIB) was proposed. Methods: Patients were categorized into CB and CIB groups according to the preoperative coronal balance distance (CBD). The apical vertebras distribution modifier was defined as negative (−) if the centers of the apical vertebras (CoAVs) were on either side of the central sacral vertical line (CSVL) and positive (+) if the CoAVs were on the same side of the CSVL. Results: A total of 80 AdIS patients, with an average age of 25.97 ± 9.20 years, who underwent posterior spinal fusion (PSF) were prospectively recruited. The mean Cobb angle of the main curve was 107.25 ± 21.11 degrees at preoperation. The mean follow-up time was 3.76 ± 1.38 (2–8) years. At postoperation and follow-up, CIB occurred in 7 (70%) and 4 (40%) CB− patients, 23 (50%) and 13 (28.26%) CB+ patients, 6 (60%) and 6 (60%) CIB− patients, and 9 (64.29%) and 10 (71.43%) CIB+ patients. Health-related quality of life (HRQoL) was significantly better in the CIB− group compared with that of the CIB+ group in the dimension of back pain. To avoid postoperative CIB, the correction rate of the main curve (CRMC) should match the compensatory curve for CB−/+ patients; the CRMC should be greater than the compensatory curve for CIB− patients; and the CRMC should be less than the compensatory curve for CIB+ patients, and the inclination of the LIV needs to be reduced. Conclusions: CB+ patients have the least postoperative CIB rate and the best coronal compensatory ability. CIB+ patients are at a high risk of postoperative CIB and have the poorest coronal compensatory capacity in the event of postoperative CIB. The proposed surgical algorithm facilitates the handling of each type of coronal alignment.

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Section: Introductionmentioning

confidence: 99%

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

Pan

Hai

Lenke

et al. 2023

JPM

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“…[ 9 10 ] Some authors have also used preoperative traction or internal distraction as a part of a staged correction, in order to achieve better correction and shorter fusion. [ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications.…”

Section: Introductionmentioning

confidence: 99%

“…[ 11 12 13 14 15 16 17 ] However, preoperative traction implies an increased risk of perioperative complications such as pin loosening, pin tract infection, and cranial nerve palsies. [ 11 12 13 14 15 16 17 ] Combined anterior and posterior or all-posterior vertebral column resection has also been used to treat severe and rigid scoliosis, but this demanding procedure is affected by a considerably high rate of perioperative complications. [ 18 19 20 ] Then, the introduction of all pedicle screws constructs allowed the all-posterior procedures to gradually gain popularity due to the high reliability of three-columnar fixation systems.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

Traversari

Ruffilli

Barile

et al. 2022

Journal of Craniovertebral Junction and Spine

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The aim of this meta-analysis was to analyze the results of one-stage all-posterior spinal fusion for severe adolescent idiopathic scoliosis (AIS). A systematic search of articles about one-stage posterior spinal fusion for severe AIS was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data about population, pre-and postoperative radiographical data, surgical procedure details, and complications were extracted. Meta-analyses were performed when possible. Fourteen studies (640 patients) were included. The mean Cobb angle of the major curve varied from 80.0 ± 7.3 to 110.8 ± 12.1. The meta analysis showed a comprehensive coronal correction rate of the major curve of 58.6%, a comprehensive operative time of 274.5 min, and a comprehensive estimated intraoperative blood loss of 866.5 mL (95% confidence interval: 659.3–1073.6, I 2 ≈ 0%). A total of 48 complications (5.4%) were reported. Overall, the meta-analysis showed a major complication rate of 4%. In seven cases, revision surgery was needed. Posterior-only approach is effective enough to correct severe curves and can spare the patient possible adverse events due to anterior approach. However, when choosing this approach for severe AIS, screw density needs to be high and posterior column osteotomies may need to be planned to mobilize the spine and maximize correction.

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“…In the spine literature, severe rigid scoliosis or kyphoscoliosis has been reportedly defined as severe spinal curves in the coronal plane with Cobb angle of ≥80°and angular curves in the sagittal plane of more than 50°and flexibility of <25% or 30%. [1][2][3][4][5][6][7] Etiologies of these severe deformities include congenital, syndromic, neuromuscular, as well as idiopathic, the latter of which less commonly become severe. [8][9][10][11] Regardless of the etiology of scoliosis or kyphoscoliosis, patients clinically presenting with acutely progressive or symptomatically severe rigid spinal deformities require timely surgical intervention to halt progression, achieve correction, restorate global spinal alignment, and improve back pain or neurological deterioration, as well as cosmetic and quality of life outcomes.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis

Halm-Lutterodt

Saidi

Mandalia

et al. 2022

Global Spine Journal

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Study Design Systematic review and meta-analysis. Objective Compilation of complication outcomes data from the surgical management of severe rigid kyphoscoliosis patients using VCR-based vs non-VCR-based corrective maneuvers is lacking. This meta-analysis aimed to compare complication outcomes between those classified osteotomy approaches. Methods Thorough literature review and meta-analysis were conducted between January 2000 and September 2021. The selection criteria were studies: i) reporting major curve Cobb angle of ≥80° and flexibility of <25% or 30%; ii) comparing VCR or ≥ Type V Schwab osteotomy defined as VCR-based vs [non-VCR-based] techniques, (any osteotomy or technique other than VCR); iii) published in English with ≥10 patients; iv) reporting complication rates; and v) having minimum of 2-year follow-up. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Significance level was set at ( P < .05). Results Of the 174 patients included, 52.30% (n = 91) and 47.70% (n = 83) were VCR-based and non-VCR-based, respectively. The incidence of dural tears/nerve injuries/significant intraoperative-neuromonitoring changes was significantly higher; [OR = 6.78, CI= (1.75 to 26.17), I2 = 0%, ( P = .006)] in the VCR-based group than the non-VCR-based group. The ‘overall surgical and medical’ complication rate was significantly higher in the VCR-based group, [OR = 1.94, CI= (1.02 to 3.67), I2 = 31%, ( P = .04)]. Conclusion Both VCR-based and non-VCR-based surgical techniques for management of severe rigid scoliosis and kyphoscoliosis patients pose comparable overall surgical complication rates, while a significantly higher perioperative neurological complication incidence was associated with VCR-based technique compared to the non-VCR-based techniques. The VCR-based technique was associated with 6.78 times higher incidence of neurological complications compared to non-VCR-based techniques.

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Preoperative skull tongs-femoral traction versus cotrel longitudinal traction for rigid and severe scoliosis: Cohort study

Cited by 5 publications

References 24 publications

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

Apical Vertebras Distribution Modifier for Coronal Balance Classification in Adult Idiopathic Scoliosis

Surgical treatment of severe adolescent idiopathic scoliosis through one-stage posterior-only approach

Comparison of Overall Complication Rates in VCR-Based vs Non-VCR-Based Corrective Techniques in Severe Rigid Kyphoscoliosis Patients: A Systematic Review and Meta-Analysis

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