Selektive ventrale Derotationsspondylodese bei idiopathischen Thorakalskoliosen: eine prospektive Studie

Bullmann, Viola; Halm, H.; Lepsien, U.; Hackenberg, Lars; Liljenqvist, U.

doi:10.1055/s-2003-37307

Cited by 11 publications

(9 citation statements)

References 10 publications

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“…A significant correction loss of an average of 2°was proved between immediate postoperative measurement and follow-up; a long-term correction of 51% was consequently achieved. Bullmann et al [8] published similar values in their prospective study comprising 64 patients with idiopathic thoracic scoliosis.…”

Section: Frontal Plane Correctionmentioning

confidence: 69%

“…This instrumentation was developed to preserve the efficiency of ventral derotation spondylodesis when a relatively short fusion length corrected scoliosis on the one hand and on the other hand to complete it in such a way that a primary stable instrumentation significantly reduced the rate of breakages and allowed brace-free postoperative care. In addition, kyphogenic effect was to be decreased [8,14,16]. In a prospective study comprising 45 patients with idiopathic scoliosis, Bullmann et al were able to show that a good correction of the scoliotic major curve and the apical rotation were achieved equally by using the Halm-Zielke instrumentation.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Muschik¹,

Kimmich²,

Demmel³

2006

Eur Spine J

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Ventral derotation spondylodesis, according to Zielke, achieves good results in operative treatment of idiopathic thoracic scolioses. Corrections of scoliotic major and secondary curve as well as derotation of the spine are reliably performed. The high rate of rod fractures with subsequent correction loss as well as a proportionate kyphogenic effect represents a problem. By keeping to the correcting principle, anterior double-rod instrumentation (Halm-Zielke Instrumentation) is to be stable in a similar way as posterior double-rod systems. Thus, it is done to facilitate brace-free postoperative care and to prevent excessive kyphotic pattern of the spine. In this prospective study, we retrospectively collected data. We performed radiological follow-up of two groups of patients with idiopathic thoracic scoliosis (King II, III and IV) undergoing an operation with posterior approach (USS instrumentation, posterior group, n=104) in 1997 and 1998 or being corrected with an anterior fusion (Halm-Zielke instrumentation, anterior group, n=37) between 2000 and 2001. Mean age of all patients for operation was 15+/-4 years. Follow-up was performed after 4+/-2 years on average. Preoperative measurements of the major and secondary curve, the lateral profile, rotation and frontal balance (C7 to S1) did not show any significant differences apart from a more severe scoliotic curve in the lumbar spine for the anterior group with appropriately higher lumbar rotation. During follow-up we noticed similar corrections of the thoracic major and lumbar curve in both groups ranging from 49 to 56%. In case of hypokyphotic (T4-T12or=40 degrees ) scolioses were flattened by posterior spinal fusion; the effect of anterior spinal fusion was not significant. Correction of thoracic and lumbar rotation in the anterior group by 37 or 30% was more significant than in the posterior group by 27 or 20%. There was no impact of anterior technique on the balance of the spine whereas the latter shifted by an average of 7 mm to the left in the posterior group. The number of fused segments was significantly smaller in the anterior group with 7+/-1 vertebral bodies (posterior, 11+/-1 vertebral bodies). Rates of complication were identical with 11 or 12% in both groups during follow-up. Anterior and posterior double-rod instrumentations result in comparable corrections for idiopathic thoracic scoliosis of the major and secondary curve. In case of posterior technique, however, four vertebral bodies less were integrated in spondylodesis on average. Balance of the spine did not change after anterior spondylodesis; however, it declined by using the posterior technique. Augmentation of the anterior threaded rod combined with a solid second rod significantly decreases the rate of implant breakages and reliably reduces consecutive correction losses.

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Section: Frontal Plane Correctionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Muschik¹,

Kimmich²,

Demmel³

2006

Eur Spine J

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“…Posterior instrumentation and fusion represent the gold standard in the treatment of idiopathic thoracic scoliosis. However, there are reports in the literature indicating favourable results of anterior instrumentation and fusion in terms of a better three-dimensional curve correction and a shorter fusion length [1,3,14,22,25,30]. In this prospective study, 23 consecutive patients were treated with an anterior dual rod instrumentation and fusion.…”

Section: Discussionmentioning

confidence: 98%

“…The average fusion length was 6.1 segments with an average frontal curve correction of 58% and a loss of correction of 1.3°within fusion levels. In publications on standard open single rod instrumentation in thoracic scoliosis the reported primary curve correction ranges from 43 to 58% with a loss of correction of 1 to 5°and a pseudarthrosis rate of up to 6% [3,7,20,22,30]. Betz et al [1] reported on a loss of correction of more than 10°in 23% of their patients.…”

Section: Discussionmentioning

confidence: 99%

“…The advantages of the anterior technique included a shorter fusion length, a better derotation and a better correction of both primary and the non-instrumented secondary lumbar curves compared to the posterior procedures. The disadvantages, however, were a higher pseudarthrosis rate due to the lack in stability with frequent rod fractures, screw pullouts and the need for postoperative bracing or even casting [1,3,14,22,25,30].…”

Section: Anterior Dual Rod Instrumentation In Idiopathic Thoracic Scomentioning

confidence: 99%

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Anterior dual rod instrumentation in idiopathic thoracic scoliosis

et al. 2006

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For anterior correction and instrumentation of thoracic curves single rod techniques are widely used. Disadvantages of this technique include screw pullouts, rod fractures and limited control of kyphosis. This is a prospective study of 23 consecutive patients with idiopathic thoracic scoliosis treated with a new anterior dual rod system. Aim of the study was to evaluate the safety and efficacy of this new technique in the surgical treatment of idiopathic thoracic scoliosis. To the best knowledge of the authors, this is the largest series on dual rod dual screw instrumentation over the entire fusion length in thoracic scoliosis. Twenty-three patients with an average age of 15 years were surgically treated with a new anterior dual rod system through a standard open double thoracotomy approach. Average clinical and radiological follow-up was 28 months (24-46 months). Fusion was carried out mostly from end-to-end vertebra. The primary curve was corrected from 66.6 degrees to 28.3 degrees (57.5% correction) with an average loss of correction of 2.0 degrees at Cobb levels and of 1.3 degrees at fusion levels. Spontaneous correction of the secondary lumbar curve averaged 43.2% (preoperative Cobb angle 41.2 degrees ). The apical vertebral rotation was corrected by 41.1% with a consecutive correction of the rib hump of clinically 66.7%. The thoracic kyphosis measured 29.2 degrees preoperatively and 33.6 degrees at follow-up. In seven patients with a preoperative hyperkyphosis of on average 47.3 degrees thoracic kyphosis was corrected to 41.0 degrees . This new instrumentation enables an entire dual rod instrumentation over the whole thoracic fusion length. It offers primary stability without the need of postoperative bracing. Dual screw dual rod instrumentation offers the advantages of a high screw pullout resistance, an increased overall stability and satisfactory sagittal plane control.

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Operative Therapie der idiopathischen Skoliose mittels ventraler Doppelstabinstrumentation

Liljenqvist

Halm²,

Lerner

et al. 2007

Orthopäde

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Selektive ventrale Derotationsspondylodese bei idiopathischen Thorakalskoliosen: eine prospektive Studie

Cited by 11 publications

References 10 publications

Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Comparison of anterior and posterior double-rod instrumentation for thoracic idiopathic scoliosis: results of 141 patients

Anterior dual rod instrumentation in idiopathic thoracic scoliosis

Operative Therapie der idiopathischen Skoliose mittels ventraler Doppelstabinstrumentation

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