Satisfactory restoration of thoracic kyphosis in Lenke I AIS curves using bilateral vertebral coplanar alignment: an international multicenter experience

Barrios, Carlos; Lajara, José M; Mazeau, Philippe; Weissmann, Karen; Lü, G. H.; Wang, Bing; Kuang, Lei; Hai, Yong; Maruenda, J. I.

doi:10.1007/s43390-020-00067-8

Cited by 3 publications

(5 citation statements)

References 32 publications

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“…VCA in AIS patients results in increased thoracic kyphosis for hypo-kyphotic patients and no changes for the normo-kyphotic and hyper-kyphotic patients. 11,14 In the current study, both the patients receiving VCA and those receiving AD achieved a satisfactory thoracic kyphosis by the end of the procedure. Following stratification by preoperative thoracic kyphosis, only the hyper-kyphotic group demonstrated flattening of thoracic kyphosis.…”

Section: Discussionsupporting

confidence: 50%

“…The correcting ability of AD has been reported between 25-60% 12,15 while the correcting ability of VCA has ranged between 52.9-56.1%. 11,14 In the current study, both techniques obtained slightly less than 50% of correction in the apical vertebral rotation, with no statistical difference in their derotation capacity. It is possible that baseline spasticity plays an important role in the rigidity seen in neuromuscular scoliosis patients and that once this factor is eliminated during anesthesia, curve correction can be achieved to comparable levels that are seen in AIS patients with more flexibile spines.…”

Section: Discussioncontrasting

confidence: 39%

“…This appears to be the main benefit of the VCA technique, as loss of kyphosis remains one of the biggest issues in pediatric deformity patients. 11 Limiting hypokyphosis is advantage in neuromuscular patients as most of them already have restrictive ventilatory patterns and diminishing kyphosis might further affect their ventilatory capacity.…”

Section: Discussionmentioning

confidence: 99%

“…Both techniques have been described in the literature. 5,11 The apical derotation technique (AD) consisted of bilateral rotation of the apical vertebrae toward the convexity, after the rods have been already placed, addressing only the apex of the deformity (Figure 1), 12 while the vertebral alignment technique (VCA) aimed at providing a simultaneous 3D correction by inserting a pre-bent rod through pre-aligned slotted tubes (Figures 2 and 3). For grafting, osteoconductors and local bone were used.…”

Section: Methodsmentioning

confidence: 99%

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Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis

Weissmann

Barrios

Lafage

et al. 2021

Global Spine Journal

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Study Design: Single-center retrospective analysis of prospectively collected data. Objective: Our aim was to compare the correction capacity in 3 planes of the VCA technique versus the AD technique in neuromuscular scoliosis patients. Methods: We analized patients with neuromuscular scoliosis that underwent posterior spinal fusion from 2013 to 2017 using 2 different techniques for correction: vertebral coplanar alignment (VCA) that takes into consideration the fact that the medial cortex is more resistant than the lateral cortex, with more anchor points for better distribution of forces and ligamentotaxis and the more widely spread apical derotation (AD) technique. Clinical, surgical, and radiographic information of patients operated on with the AD technique were compared to those operated on with the VCA technique in the coronal, sagittal and axial plane at pre-op, immediate post-op, and 2 year follow-up. Results: 64 patients met inclusion criteria, 34 patients underwent the VCA technique and 30 patients underwent the AD technique. The 2 cohorts did not differ in terms of demographics, clinical presentation or preoperative alignment. There were no significant differences in the correction ability between both techniques regarding curve magnitude, apical vertebral rotation, or pelvic obliquity. There was a significant decrease in thoracic kyphosis in the AD group compared to the VCA group in the immediate postop period (4.2 ± 26.6º for VCA and 13.2 ± 21.3º for AD (p = 0.048)). Conclusion: Both apical derotation technique and vertebral coplanar alignment allow for correction in the 3 planes for patients with neuromuscular scoliosis. VCA is a less hypokyphosing technique than AD.

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Section: Discussionsupporting

confidence: 50%

Section: Discussioncontrasting

confidence: 39%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis

Weissmann

Barrios

Lafage

et al. 2021

Global Spine Journal

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“…Recently, many newer instrumentation techniques, including DVR 7 , cantilever bending technique 6 , differential rod contouring 10 , bilateral vertebral coplanar alignment maneuver 11 , simultaneous double-rod rotation technique 12 , and simultaneous translation 13 , have been developed to gain three-dimensional reduction of scoliosis. In terms of the coronal correction rate, our procedure showed a coronal correction similar to that of recent papers that showed an approximately 70%-80% correction rate [5][6][7][12][13][14][15][16][17][18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of a New Technique Using a Convex Rod Rotation Maneuver for Adolescent Idiopathic Scoliosis

Takahashi

Terai

Toyoda

et al. 2021

Spine Surg Relat Res

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Introduction Because of adolescent idiopathic scoliosis (AIS), most surgeons use rod rotation on the concave side for Lenke types 1 and 2 curves. Nevertheless, the accurate placement of pedicle screws within dysplastic pedicles, especially on the concave side, is sometimes challenging. Conversely, there is a concern that apical rotation might be exacerbated after convex rod rotation maneuver (RRM) because the rod is rotated in the same direction as vertebral rotation. This study aims to demonstrate the surgical technique and outcomes of a convex RRM with direct vertebral rotation (DVR) for the correction of AIS. Technical Note Multilevel pedicle screws were inserted into the vertebrae. The pre-bent pure titanium rod was set on the convex side and then derotated to nearly 90°. DVR was conducted for the desired vertebrae. Another pre-bent titanium alloy rod, for placement on the concave side, was contoured the same as the rod on the convex side. Using a reduction tube that allowed easier capture of the rod, the rod was connected to the concave side screws. DVR was again conducted for the desired vertebrae. Among the 59 patients, the correction rate of the main thoracic curve in Lenke types 1 and 2 AIS was 75.1% and 65.0%, respectively. The absolute value of the change in apical vertebral rotation between pre- and post-operative computed tomography (CT) scans in Lenke types 1 and 2 curves was 4.8° and 4.2°, respectively. Conclusions The convex RRM improved vertebral rotation in Lenke types 1 and 2 AIS. This procedure should be regarded as one of the surgical options for AIS, especially in patients with a narrow pedicle width on the concave side.

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Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment?

et al. 2022

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Satisfactory restoration of thoracic kyphosis in Lenke I AIS curves using bilateral vertebral coplanar alignment: an international multicenter experience

Cited by 3 publications

References 32 publications

Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis

Vertebral Coplanar Alignment Technique Versus Bilateral Apical Vertebral Derotation Technique in Neuromuscular Scoliosis

Surgical Outcomes of a New Technique Using a Convex Rod Rotation Maneuver for Adolescent Idiopathic Scoliosis

Restoration of thoracic kyphosis in adolescent idiopathic scoliosis with patient-specific rods: did the preoperative plan match postoperative sagittal alignment?

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