Single rod instrumentation in patients with scoliosis and co-morbidities: Indications and outcomes

Abstract

AIMTo present our results on the use of a single rod instrumentation correction technique in a small number of patients with major medical co-morbidities.METHODSThis study was a prospective single surgeon series. Patients were treated with single rod hybrid constructs and had a minimum 2-year follow-up. Indications included complex underlying co-morbidities, conversion of growing rods to definitive fusion, and moderate adolescent idiopathic primarily thoracic scoliosis with severe eczema and low body mass index (BMI).RESULTSWe included 99 consecutive patients. Mean age at surgery was 12.8 years (SD 3.5 years). Mean scoliosis correction was 62% (SD 15%) from 73° (SD 22°) to 28° (SD 15°). Mean surgical time was 153 min (SD 34 min), and blood loss was 530 mL (SD 327 mL); 20% BV (SD 13%). Mean clinical and radiological follow-up was 3.2 years (range: 2-12) post-operatively. Complications included rod failure, which occurred in three of our complex patients with severe syndromic or congenital kyphoscoliosis (3%). Only one of these three patients required revision surgery to address a non-union. Our revision rate was 2% (including a distal junctional kyphosis in a Marfan’s syndrome patient).CONCLUSIONThe single rod technique has achieved satisfactory deformity correction and a low rate of complications in patients with specific indications and severe underlying medical conditions. In these children with significant co-morbidities, where the risks of scoliosis surgery are significantly increased, this technique has achieved low operative time, blood loss, and associated surgical morbidity.

Posterior Vertebral Pedicular Tethering for the Treatment of Idiopathic Adolescent Scoliosis

“…In the case of complications, where revision is required, this posterior approach has numerous other advantages—in the case of coronal or sagittal over-correction, with a minor procedure under local anaesthetic in most cases, you are able to cut the tether at the different levels you intended to. In the case of unacceptable under-correction or curve progression, you are able to approach the spine through the same skin incision and perform a posterior spinal instrumented fusion with concave side instrumentation only, which has been shown to achieve good results [ 40 ]. In the case of screw pull-out or loosening or a broken tether that requires revision, everything can be performed from the posterior approach as a less invasive procedure with no majors risks or concerns.…”

A 43-Year Follow-Up of Unilateral Harrington Rod Instrumentation and Limited Fusion for Adolescent Idiopathic Scoliosis

“…In a recent systematic review, the majority of published reports regarding unilateral instrumentation for degenerative spine conditions involved only a single lumbar level [ 11 ]. The use of unilateral pedicle screw instrumentation for spine deformity has been described by Tsirikos et al who reported a single-center series of multi-level unilateral instrumentation (pedicle screws/hook-rod construct) for scoliosis with minimal complications in selected patients [ 12 ]. The same group has also reported the use of low-density pedicle screws on the concavity of the curve (proximal/distal aspect of the construct) and instrumenting most levels on the convexity of the curve [ 13 , 14 ].…”

Surgical treatment of progressive idiopathic scoliosis in adolescents aged 10–14 years: literature review

“…Tsirikos et al [28] Kim et al [31] провели сравнительный анализ результатов хирургического лечения 52 подростков с идиопатическим сколиозом. Все пациенты были разделены на 2 равные группы в зависимости от применяемой техники хирургического вмешательства.…”